Monitoring of extubated patients: are routine arterial blood gas measurements useful and how long should patients be monitored in the intensive care unit?

The authors aimed to investigate whether serial arterial blood gas measurements done in the post-extubation period would help to identify patients requiring restitution of ventilatory support and to determine the optimal duration of close monitoring post-extubation. One hundred and fifteen adult patients were retrospectively analysed. 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 19.1% of patients. The vast majority (20/22) of patients were patients previously intubated for pnemonia. 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. The authors concluded that 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.

See KC, Phua J, Mukhopadhyay A. Anaesthesia and Intensive Care. 2010; 38(1): 96-101