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 Table of Contents  
Year : 2014  |  Volume : 4  |  Issue : 2  |  Page : 56-57

Introducing 'A-Z' algorithm for extubation

Department of Neurosurgery, College of Medical Sciences, Bharatpur, Nepal

Date of Submission11-Aug-2014
Date of Acceptance20-Aug-2014
Date of Web Publication21-Jan-2015

Correspondence Address:
Sunil Munakomi
Department of Neurosurgery, College of Medical Sciences, Bharatpur
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2230-7095.149784

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How to cite this article:
Munakomi S, Tamrakar K. Introducing 'A-Z' algorithm for extubation. Int J Stud Res 2014;4:56-7

How to cite this URL:
Munakomi S, Tamrakar K. Introducing 'A-Z' algorithm for extubation. Int J Stud Res [serial online] 2014 [cited 2022 Jan 29];4:56-7. Available from: http://www.ijsronline.net/text.asp?2014/4/2/56/149784

Dear Editor,

Weaning and extubation are terms that are commonly encountered in critical care. In an intensive care setup, weaning is a process in which a patient is suspended off the ventilator following resolution of illness, whereas extubation refers to the removal of the endotracheal tube from the trachea. Although both these processes follow each other closely in clinical practice, it is essential to understand these terms as two discrete processes that pose distinct problems.

Extubation failure is defined as inability to sustain spontaneous breathing subsequent to removal of the artificial airway, essentially an endotracheal tube or tracheostomy tube, and necessitating re-intubation within a specified time period, either within 24-72 hours [1],[2] or up to 7 days. [3],[4] Substantial literature exists about weaning predictors and outcomes, most being inaccurate in predicting extubation outcome. To predict "extubation failure" is essential, as both delayed and failed extubation have detrimental consequences such as prolonged ventilation and intensive care stay, need for tracheostomy, increased cost of treatment and mortality. [5],[6],[7]

In this letter, we describe a self-formulated algorithm using English alphabets as a checklist to be used as a guideline prior to extubating a patient [Table 1]. The checklist depicted in the algorithm would help minimize complications, improve patient care and reduce the risk of reintubation.
Table 1: A-Z criteria for extubation in an intubated or in patient with tracheostomy

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We conclude that the above formulated algorithm may be helpful for residents and staff working in the intensive and critical care setup by providing an easy and quick checklist prior to weaning process for prevention of failed extubation and decreasing the morbidities associated with it.

Author's Contributions

The authors contributed equally to the paper and confirm that they have read and approved the final version of the manuscript.

Competing Interest



Sources of funding: None

  References Top

Smina M, Salam A, Khamiees M, et. al. Cough peak flows and extubation outcomes. Chest 2003;124:262-8.   Back to cited text no. 1
Martinez A, Seymour C, Nam M. Minute ventilation recovery time: a predictor of extubation outcome. Chest 2003;123;1214-21.  Back to cited text no. 2
Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;112:186-92.  Back to cited text no. 3
Esteban A, Alía I, Gordo F, et. al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med 1997;156:459-65.  Back to cited text no. 4
Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998;158:489-93.  Back to cited text no. 5
Seymour CW, Martinez A, Christie JD, Fuchs BD. The outcome of extubation failure in a community hospital intensive care unit: a cohort study. Crit Care 2004;8:R322-7.  Back to cited text no. 6
Torres A, Gatell JM, Aznar E, el Ebiary M, Puig DL, Gonzalez J, et. al . Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995;152:137-41.  Back to cited text no. 7


  [Table 1]


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