title: Monitoring of extubated patients: are routine arterial blood gas measurements useful and how long should patients be monitored in the intensive care unit?
abstract: Restitution of respiratory support, which may include continuous positive airway pressure, non-invasive ventilation or reintubation, is needed in some patients post-extubation. We aimed to investigate whether serial arterial blood gas measurements done in the post-extubation period would help to identify such patients and to delineate the optimal post-extubation duration for close monitoring. We retrospectively analysed 115 consecutive adult patients who were extubated following successful spontaneous breathing trials in the medical intensive care unit, excluding patients who were extubated to immediate non-invasive ventilation. Arterial blood gases were measured at one and three hours post-extubation and patients were followed for any restitution of respiratory support for the remainder of their hospital stay. Restitution of respiratory support was required for 22 of 115 (19.1%) patients, of whom 20 were originally intubated for pneumonia. These patients could all be detected clinically from deteriorating pulse oximetry or increasing drowsiness. Performing serial arterial blood gas measurements following extubation did not improve the detection rate or allow earlier detection of patient deterioration. Among the patients with pneumonia, restitution of respiratory support was required within 24 hours of extubation for 16 patients (80%) and after more than 49 hours for four patients. Serial arterial blood gas measurements at one and three hours after a planned extubation are not useful and patients originally intubated for pneumonia should be monitored post-extubation for at least 24 hours in the intensive care unit.
authors.affiliation: Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore.
authors.forename: K C
authors.initials: KC
authors.lastname: See
authors.forename: J
authors.initials: J
authors.lastname: Phua
authors.forename: A
authors.initials: A
authors.lastname: Mukhopadhyay
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D001784:Blood Gas Analysis; D015331:Cohort Studies; D003625:Data Collection; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010092:Oximetry; D012121:Respiration, Artificial; D015300:Ventilator Weaning