Editorial Views  |   October 2017
Extubation, Black Boxes, and Ontology
Author Notes
  • From the Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, Illinois.
  • Corresponding article on page 666.
    Corresponding article on page 666.×
  • Accepted for publication June 26, 2017.
    Accepted for publication June 26, 2017.×
  • Address correspondence to Dr. Tobin: mtobin2@lumc.edu
Article Information
Editorial Views / Airway Management
Editorial Views   |   October 2017
Extubation, Black Boxes, and Ontology
Anesthesiology 10 2017, Vol.127, 599-600. doi:10.1097/ALN.0000000000001833
Anesthesiology 10 2017, Vol.127, 599-600. doi:10.1097/ALN.0000000000001833
IN the present issue of Anesthesiology, Silva et al.1  report on the ability of thoracic ultrasound to predict the development of respiratory distress in patients extubated after tolerating 60 min of pressure support set at 7 cm H2O. They studied 136 patients, and 18.4% required reintubation. Integrated statistical models based on thoracic ultrasound data, encompassing respiratory, cardiac, and diaphragmatic variables, predicted the development of postextubation distress with remarkable accuracy (receiver operating characteristic curves greater than 0.90). The sonographic data of greatest reliability were signs of pulmonary edema and increased diastolic left-ventricular pressure.
The study deals with an important question: development of respiratory failure after extubation. The data are novel as thoracic ultrasound has not been widely applied in decision-making about weaning/extubation. The findings are biologically plausible: cardiac problems and pulmonary edema can be responsible for respiratory failure after removal of mechanical ventilation.2 
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