Listello and Sessler identified a number of factors associated with the need to reintubate a patient following unplanned extubation. Many patients can be safely observed without the need for immediate reintubation. The authors are from the Medical College of Virginia.
Patient selection: unplanned extubation of a patient in the ICU
Parameters
(1) type of mechanical ventilation
(2) arterial pH, most recent prior to unplanned extubation
(3) ratio of PaO2 to FIO2, most recent prior to unplanned extubation
(4) maximum heart rate in the 24 hours prior to the unplanned extubation
(5) number of comorbid conditions out of 7 (history of COPD, history of CHF, renal dysfunction, liver dysfunction, neurologic disorder such as seizure, stroke or coma, receiving antibiotics, electrolyte abnormality).
(6) mental status
(7) indication for intubation
|
Parameters |
Findings |
Points |
|
type of mechanical ventilation |
volume controlled with rate > 6 per minute |
1 |
|
|
other |
0 |
|
arterial pH |
>= 7.45 |
1 |
|
|
< 7.45 |
0 |
|
ratio of PaO2 to FIO2 |
< 250 mm Hg |
1 |
|
|
>= 250 mm Hg |
0 |
|
maximum heart rate |
<= 120 beats per minute |
0 |
|
|
> 120 beats per minute |
1 |
|
number of comorbid conditions |
0 to 2 |
0 |
|
|
>= 3 |
1 |
|
mental status |
alert |
0 |
|
|
not alert |
1 |
|
indication for intubation |
preoperative |
0 |
|
|
other |
1 |
where:
• Volume controlled ventilation was either synchronous intermittent mandatory ventilation or assist-control ventilation.
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• The higher the score the more likely that the patient will need to be reintubated.
• The authors found that a score >= 4 identified most patients who required reintubation..
Specialty: Pulmonology
ICD-10: ,
