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Related Concept Videos

Endotracheal Tube Extubation01:24

Endotracheal Tube Extubation

346
Endotracheal tube extubation is a critical procedure in weaning patients from mechanical ventilation. It involves physically removing the oral or nasal endotracheal (ET) tube, marking the final step in liberating a patient from ventilatory support.
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
346
Endotracheal Intubation II: Nursing Management01:17

Endotracheal Intubation II: Nursing Management

430
Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
430
Endoscopic Studies II: Thoracocentesis01:26

Endoscopic Studies II: Thoracocentesis

195
Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
195
Endotracheal Intubation I: Procedure01:15

Endotracheal Intubation I: Procedure

605
Endotracheal or ET intubation is a critical medical procedure used to secure a patient's airway, often in acute respiratory distress, apnea, upper airway obstruction, ineffective clearance of secretions, high risk for aspiration, or during general anesthesia.
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
605
Tracheostomy Decannulation01:21

Tracheostomy Decannulation

91
Tracheostomy decannulation is a significant milestone in the liberation of mechanically ventilated patients. Despite its importance, there is no universally accepted protocol for this procedure. This demands an evidence-based, individualized approach.
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
91

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Related Experiment Video

Updated: May 28, 2025

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
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Extubation Failure in Neonates Following Congenital Cardiac Surgery: Multicenter Retrospective Cohort, 2017-2020.

Daniel L Hames1,2, Qalab Abbas3, Ahmed Asfari4

  • 1Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, MA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|February 10, 2025
PubMed
Summary

Extubation failure is common in neonates after heart surgery. New algorithms monitoring oxygen and carbon dioxide levels may help predict this risk.

Keywords:
cardiac surgerycongenital heart diseaseextubation failurepostoperative carerisk analytics

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Area of Science:

  • Neonatal physiology
  • Pediatric cardiac surgery
  • Critical care medicine

Background:

  • Extubation failure (EF) in neonates post-congenital cardiac surgery is linked to increased morbidity and mortality.
  • Continuous physiologic monitoring and risk analytics offer potential to identify neonates at high risk for EF.

Purpose of the Study:

  • To evaluate the association of two physiologic risk analytics algorithms, inadequate delivery of oxygen index (IDo2) and inadequate ventilation of carbon dioxide index (IVCO2), with EF in neonates receiving mechanical ventilation (MV) after cardiac surgery.
  • To identify clinical factors associated with EF.

Main Methods:

  • Multicenter retrospective cohort study involving eight international pediatric cardiac ICUs.
  • Analysis of data from 736 neonates (age < 1 month) receiving MV for >48 hours post-cardiac surgery (2017-2020).
  • Utilized multivariable analysis to assess associations between clinical factors, IDo2, IVCO2, and EF.

Main Results:

  • Extubation failure (reintubation within 48 hours) occurred in 13.9% of neonates.
  • Preoperative respiratory support was associated with increased odds of EF (OR, 1.72).
  • In neonates with both IDo2 and IVCO2 data, single ventricle anatomy (OR, 2.50) and high IDo2 (≥25) or high IVCO2 (≥50) in the 2 hours pre-extubation were associated with greater odds of EF (OR, 1.77).

Conclusions:

  • Extubation failure remains a significant issue in neonates requiring prolonged mechanical ventilation post-cardiac surgery.
  • The IDo2 and IVCO2 algorithms show promise as tools for assessing extubation failure risk in this vulnerable population.