Reengineering Respiratory Support Following Extubation: Avoidance of Critical Care Unit Costs

Study objective We prospectively investigated alternative clinical practice strategies for critically ill trauma patients following extubation to evaluate the cost-effectiveness of these maneuvers. The primary change was elimination of the routine use of postextubation supplemental oxygen, with concurrent utilization of noninvasive positive pressure ventilatory support (NPPV) to manage occurrences of postextubation hypoxemia. Design Prospective, consecutive accrual of patients undergoing extubation. Setting Trauma ICU in a university hospital. Interventions and measurements All patients received mechanical ventilation using pressure support ventilation (PSV) with continuous positive airway pressure (CPAP) as the primary mode. The patients were extubated to room air following a 20-min preextubation trial of 5 cm H 2 O CPAP at F io 2 of 0.21, and demonstrating a spontaneous respiratory rate ≤ 38 breaths/min, pH ≥ 7.30, Pa co 2 ≤ 50 mm Hg, and Pa o 2 ≥ 50 mm Hg. The subgroup of patients who became hypoxemic (pulse oximetric saturation Conclusion Eliminating the routine use of supplemental oxygen and employing NPPV as a method to prevent reintubation can facilitate a more aggressive, cost-effective strategy for the management of the trauma ICU patient who has been extubated.