Prevention of Post-extubation Failure in Critically Ill Obese Patient

The decision to extubate a morbidly obese patient can be fraught with significant challenges. Several lines of evidence suggest that extubation failure requiring reintubation prolongs hospital stay, predisposes to hospital-acquired pneumonia, and can worsen outcomes. Risk factors for failure to sustain spontaneous breathing can be classified into unresolved underlying conditions like respiratory impairment, recurrent aspiration, sepsis, or the onset of a new complication related to prolonged mechanical ventilation such as upper airway obstruction, delirium, or ICU-acquired neuropathy. Daily screening followed by a weaning test and then by extubation if the test is successful can shorten the intubation time without increasing the risk of reintubation. Institution of prophylactic noninvasive positive pressure ventilation immediately after extubation can reduce reintubation rate and may improve mortality in those who are hypercapnic.