• Kunut Kijsirichareanchai, Chok Limsuwat, Charoen Mankongpaisarnrung, Nopakoon Nantsupawat, and Kenneth Nugent.
• Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA.
• J Intensive Care Med. 2014 Sep 1; 29 (5): 260-8.

BackgroundPatients with failed extubation requiring reintubation have increased morbidity and mortality. This situation may reflect the severity of the underlying disorder or may reflect an undiagnosed condition that was not apparent at the time of the initial intubation.MethodsCase report and literature review.ResultsA 49-year-old man developed acute hypercapneic respiratory failure during an episode of community-acquired pneumonia. This patient failed extubation 4 times. Routine neurological evaluation, including computed tomography of the head, was within normal limits. A magnetic resonance imaging revealed a severe Chiari malformation type I. The patient eventually required tracheostomy and prolonged mechanical ventilation. We identified 28 cases with Chiari malformations (CM) in the medical literature, who presented with respiratory failure. The mean age was 29.5 years, 46% of the cases were male, 50% had an associated syringomyelia, and 64% required a decompressive surgery. Twenty-five percent had recurrent symptoms postsurgery.ConclusionsPatients with CMs can have repeated extubation failures. Some of these patients have normal neurological examinations and studies and are not identified until they have an MRI study. Clinicians need to consider this possibility in patients who are difficult to wean.© The Author(s) 2013.

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