Monitoring and mechanical ventilator setting during noninvasive mechanical ventilation: Key determinants in post-extubation respiratory failure

Extubation failure is usually defined as the need for reintubation within 48–72 h following extubation [1]. Patients may be unable to maintain spontaneous breathing for multiple reasons: increased workload of breathing, cardiovascular dysfunction, airway obstruction, or excessive secretions. The incidence of post-extubation respiratory failure ranges between 10 and 20 % [2]. Patients who fail extubation have higher mortality, consistently reported at about 20–50 % in intensive care units (ICUs), and longer ICU and hospital stays [3]. Reintubation is a risk factor for ventilator-associated pneumonia [4] and is independently associated with ICU mortality [3, 5, 6]. A minority of reintubated patients die in the first 24 h after reintubation, whereas mortality increases with time to reintubation [7]. Moreover, upper-airway obstruction is the reason for reintubation in about 5–15 % of cases, but no increase in mortality has been reported in this population [7]. Thus, three scenarios explain the higher mortality rate: (1) reintubation entails risks per se, (2) it is a marker for severity of illness, or (3) it is a consequence of a new event occurring between extubation and reintubation.