List Archives

Sat, 5 Jan 2002 11:45:29 -0500

Funny you should ask...
--------------------------
William M. Coplin, MD
Associate Professor, Neurology & Neurological Surgery
Wayne State University
Chief, Neurology; Medical Director, Neurotrauma & Critical Care
Detroit Receiving Hospital


1.	Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. =
Implications of extubation delay in brain-injured patients meeting =
standard weaning criteria. American Journal of Respiratory & Critical =
Care Medicine 2000;161(5):1530-1536.=0D	We hypothesized that variation =
in extubating brain injured patients would affect the incidence of =
nosocomial pneumonia, length of stay, and hospital charges. In a =
prospective cohort of consecutive, intubated brain-injured patients, we =
evaluated daily: intubation status, spontaneous ventilatory parameters, =
gas exchange, neurologic status, and specific outcomes listed above. Of =
136 patients, 99 (73%) were extubated within 48 h of meeting defined =
readiness criteria. The other 37 patients (27%) remained intubated for a =
median 3 d (range, 2 to 19). Patients with delayed extubation developed =
more pneumonias (38 versus 21%, p < 0.05) and had longer intensive care =
unit (median, 8.6 versus 3.8 d; p < 0.001) and hospital (median, 19.9 =
versus 13.2 d; p =3D 0.009) stays. Practice variation existed after =
stratifying for differences in Glasgow Coma Scale scores (10 versus 7, p =
< 0.001) at time of meeting readiness criteria, particularly for =
comatose patients. There was a similar reintubation rate. Median =
hospital charges were $29,057.00 higher for extubation delay patients (p =
< 0.001). This study does not support delaying extubating patients when =
impaired neurologic status is the only concern prolonging intubation. A =
randomized trial of extubation at the time brain-injured patients =
fulfill standard weaning criteria is justifiable.=0D
> ----------
> From: 	Keith D. Lamb
> Sent: 	Saturday, January 5, 2002 11:43
> To: 	trauma-list@trauma.org; ccm-l@list.pitt.edu
>=20
> There has been some discussion on another list regarding the use of =
GCS to help determine a patients rediness to be decannulated =
(tracheostomy). Has anyone used this as an adjunct to other clinical =
tools to make this decision. The discussion was primarily oriented to =
those patients that had some neuro deficit originally...i.e.. CVA or =
neuro-trauma. Thanks.
> =20
> Keith
> =20
> Keith D. Lamb RCP, RRT
> Christiana Care Hospital
> Newark, Delaware
> pager/phone 302 983 6178
>=20

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