A Decision-Tree Model for Predicting Extubation Outcome in Elderly Patients After a Successful Spontaneous Breathing Trial

Abstract

If the current tree model is confirmed by a prospective study with a larger sample size, it would be useful in guiding physicians making extubation decisions in elderly medical intensive care unit patients.

Voluntary Is Better Than Involuntary Cough Peak Flow for Predicting Re-Intubation After Scheduled Extubation in Cooperative Subjects

“…[1][2][3] Nevertheless, 12.4 -21% of patients require re-intubation within 48 -72 h, although they have a successful SBT. [4][5][6][7][8] This results from many reasons, such as weak cough, large amount of secretions, advanced age, impaired neurological status, or laryngospasm. 9,10 Furthermore, re-intubation is associated with a 5-fold increase in the relative odds of death and a 2-fold increase in median ICU and hospital stay, as well as institutional costs.…”

Predictors of Reintubation in Critically Ill Patients

“…1 Single-point-in-time examination of the ratio of respiratory frequency to tidal volume (the rapid shallow breathing index), integration of thoracic compliance, breathing frequency, arterial oxygenation, and maximum occlusion pressure, or dynamic changes in these indices over the course of the SBT differentiate between successes and failures of this trial. [2][3][4] Nonetheless, even after passing an SBT, nearly one in 5 will require reintubation at some time during the hospital stay, with half of these patients requiring reintubation within the first 24 hours. 3,5 Salam et al 6 reported the ability to maintain a patent upper airway and clear secretions, indicated by a cough peak SEE THE RELATED EDITORIAL ON PAGE 301 flow Ͼ 60 L/min, tracheal secretions Ͻ 2.5 mL/min, and the ability to follow 4 simple tasks (ie, open eyes, track with eyes, grasp with hands, and stick out tongue) increased the odds of successful extubation.…”

“…[2][3][4] Nonetheless, even after passing an SBT, nearly one in 5 will require reintubation at some time during the hospital stay, with half of these patients requiring reintubation within the first 24 hours. 3,5 Salam et al 6 reported the ability to maintain a patent upper airway and clear secretions, indicated by a cough peak SEE THE RELATED EDITORIAL ON PAGE 301 flow Ͼ 60 L/min, tracheal secretions Ͻ 2.5 mL/min, and the ability to follow 4 simple tasks (ie, open eyes, track with eyes, grasp with hands, and stick out tongue) increased the odds of successful extubation. Mokhlesi and colleagues 7 reported on 122 patients who were followed after extubation to identify those who were reintubated within 48 hours.…”

Prediction of Early and Late Re-intubation: Is It a Crossed or Separate Line?—Reply

“…The authors indicate a median time to re-intubation of 22 h, but the results suggest that only 41% of all re-intubated patients (155 of 379) were re-intubated in the first 24 h. Time periods for risk of extubation failure of 48 and 72 h have been more commonly studied. [2][3][4][5] In contrast, after a number of days, unforeseen conditions can develop in critically ill patients and be responsible for a new respiratory failure. 3 Can an extubation failure 6 days after extubation be reasonably predicted?…”

“…In contrast, the response to changes in neurological status (encephalopathy) measured by the Glasgow coma scale during so short a period as 40 min might not be the same as that in long time periods at high F IO 2 because of the diffusing capacity for carbon monoxide in cerebrospinal fluid. 5,6 The authors did not provide data on dead space measurement or previous pulmonary hypertension values, and hypercapnia could affect clinical measurements.…”