Abstract
The term weaning is used to describe the process of gradual ventilatory support discontinuation so the patient progressively assumes the entire respiratory effort and work of breathing till the complete independence from the mechanical ventilator. Time spent in the weaning process is about 40–50% of the total duration of MV. In the elder patients, the interruption of mechanical support and the rapid extubation play an important role to ensure the best clinical outcome. Reducing the length of mechanical ventilation decreases the risk of complications (e.g., infections, injury to the lungs and other organs), but premature discontinuation of mechanical ventilation can produce other complications and increase mortality. This chapter describes extubation and reintubation conditions of elder patients who require weaning from MV during ICU recovery. Risk factors and complications of planned extubation failure in elder patients are generally different from younger ages and they are affected by the severity of illness, inability to handle secretions, age, upper airway obstruction, weak and ineffective cough, muscular weakness, underlying cardiopulmonary disease, and low albumin levels <2.5 g/dL.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- BNP:
-
B-type natriuretic peptide
- ET:
-
Endotracheal tube
- FiO2 :
-
Fraction of inspired oxygen
- GCS:
-
Glasgow coma scale
- ICU:
-
Intensive care unit
- MAP:
-
Mean arterial pressure
- MOF:
-
Multiple organ failure
- MV:
-
Mechanical ventilation
- P/F:
-
Oxygen arterial pressure/fraction of oxygen inspired
- PEEP:
-
Positive end-expiratory pressure
- PEF:
-
Peak expiratory flow
- PSV:
-
Pressure support ventilation
- RSBI:
-
Rapid shallow breathing index
- SBT:
-
Spontaneous breathing trial
- V t :
-
Tidal volume
References
El Solh AA, Bhat A, et al. Extubation failure in elderly. Respir Med. 2004;98(7):661–8.
Chockalingam T. Weaning and extubation. J Lung Pulm Respir Res. 2015;2(3):59–60.
MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinhorn DJ, American College of Chest Physicians, American Association for Respiratory Care, American College of Critical Care Medicine. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001;120(6 Suppl):375S–95S.
Thille AW, Richard JC, Brochard L. The decision to extubate in intensive care unit. Am J Respir Crit Care Med. 2013;187(12):1294–302.
Thille AW, et al. Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care. 2013;19(1):57–64.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Vargas, M., Servillo, G., Acampora, A. (2020). Extubation and Reintubation Conditions. In: Esquinas, A., Vargas, N. (eds) Ventilatory Support and Oxygen Therapy in Elder, Palliative and End-of-Life Care Patients . Springer, Cham. https://doi.org/10.1007/978-3-030-26664-6_21
Download citation
DOI: https://doi.org/10.1007/978-3-030-26664-6_21
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-26663-9
Online ISBN: 978-3-030-26664-6
eBook Packages: MedicineMedicine (R0)