ICU Cases · Advanced respiratory support
Hot case — the bedside: the post-extubation assessment
A CICM hot case — a bedside encounter on the post-extubation distress. Tests the recognition of the failure, the cause (the laryngeal oedema, the secretions, the cardiac), and the decision to start the NIV or to reintubate.
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CICMFFICMEDIC
Prompt
At the bedside of a 65-year-old man, 30 minutes after his extubation, who is tachypnoeic and in distress. Assess him and decide the next step.
Presentation
You are taken to the bedside of an older man, shortly after his extubation following several days of ventilation for a pneumonia. He is markedly tachypnoeic, using his accessory muscles, with a low saturation on a high-flow mask, and he is diaphoretic and agitated. The nurse asks you to assess him.[2]
References2ShowHide
- [1]Esteban A, Frutos-Vivar F, Ferguson ND, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. New England Journal of Medicine, 2004.PMID 15190137
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.