SAFE EXTUBATION AND REINTUBATION IN OPERATORY ROOM AND ICU PATIENTS

Abstract

Each intubation should result in an extubation at end of procedure, and each extubation, theoretically, could represent a potential reintubation due to extubation manoeuvre failure. There are many and different reasons for extubation to fail, starting from mechanical iatrogenic lesions due to difficult intubation up to patient’s inhability to sustain spontaneous breathing and unassisted ventilation, going through extubation associated respiratory and cardiovascular complications, local mechanic or inflammatory factors, surgical techniques and accidental events. Recent literature has clearly shown that if critical events associated with difficult intubation have lower incidence thanks to guidelines diffusion and implementation, extubation related accidents did not change incidence and consequences in last couple of decades. This observation has led to developement of dedicated extubation guidelines and to attention from Scientific Community to promote culture of safety and anticipation, with predicted difficult extubation concept and protected extubation strategies, by using pharmacological and technical approach. Aim of this paper is to review data for extubation related accidents, to provide overview with existing guidelines and description of approaches to predict difficult extubation, techniques to provide best extubation strategies including pharmacologic, non pharmacologic and instrumental techniques.

Keywords

• safe extubation
• reintubation
• operatory room
• ICU