Establishing failure predictors for the planned extubation of overweight and obese patients

Abstract

We investigated failure predictors for the planned extubation of overweight (body mass index [BMI] = 25.0–29.9) and obese (BMI ≥ 30) patients. All patients admitted to the adult intensive care unit (ICU) of a tertiary hospital in Taiwan were identified. They had all undergone endotracheal intubation for > 48 h and were candidates for extubation. During the study, 595 patients (overweight = 458 [77%]); obese = 137 [23%]) with planned extubation after weaning were included in the analysis; extubation failed in 34 patients (5.7%). Their mean BMI was 28.5 ± 3.8. Only BMI and age were significantly different between overweight and obese patients. The mortality rate for ICU patients was 0.8%, and 2.9% for inpatients during days 1–28; the overall in-hospital mortality rate was 8.4%. Failed Extubation group patients were significantly older, had more end-stage renal disease (ESRD), more cardiovascular system-related respiratory failure, higher maximal inspiratory pressure (MIP), lower maximal expiratory pressure (MEP), higher blood urea nitrogen, and higher ICU- and 28-day mortality rates than did the Successful Extubation group. Multivariate logistic regression showed that cardiovascular-related respiratory failure (odds ratio [OR]: 2.60; 95% [confidence interval] CI: 1.16–5.80), ESRD (OR: 14.00; 95% CI: 6.25–31.35), and MIP levels (OR: 0.94; 95% CI: 0.90–0.97) were associated with extubation failure. We conclude that the extubation failure risk in overweight and obese patients was associated with cardiovascular system-related respiratory failure, ESRD, and low MIP levels.

Expiratory muscle dysfunction in critically ill patients: towards improved understanding

“…Most studies used the maximum expiratory pressure (MEP) as a marker of expiratory muscle strength [48–57]. Despite the heterogeneity of the studies in terms of populations and measurement techniques, the MEP was lower than the reference values [63] in all studies that obtained MEP at the time of ventilator weaning [48–55, 64]. Patients failing extubation exhibit a lower MEP (mean decrease varying from 9 to 31 cmH 2 O) compared with extubation success patients [48–55, 64].…”

Pathophysiology and Management of Acute Respiratory Distress Syndrome in Obese Patients

“…136 A recent study assessed the predictors of failure for the planned extubation of obese patients. 137 The authors found how patients who failed the extubation were significantly older, had a higher prevalence of end-stage renal disease, were more likely to have a cardiac cause underlying the respiratory failure, had less negative maximal inspiratory pressure, and lower maximal expiratory pressure (reflecting an inadequate power of respiratory muscles to overcome the burden of the large body size). In contrast to nonobese patients, the rapid shallow breathing index (respiratory rate/tidal volume ratio) was not helpful as a predictor of extubation failure, likely because of the altered respiratory physiology of obesity.…”

Association of independent risk factors with post-extubation failure in patients undergoing mechanical ventilation weaning

“…Several reviews refer an association between general obesity and EF; however, there are few studies reporting the association of visceral obesity and EF risk. 16,17 Comorbidities such as sedentary lifestyle, smoking, type 2 diabetes, systemic arterial hypertension, acute coronary syndrome and chronic kidney failure were more common in men, while immune comorbidities were more prevalent in women; on the other hand, surgical and non-surgical causes of admission were more common in men. No association was found between admission causes and EF risk.…”

“…11,12 EF-related risk factors have been investigated and reported in different studies; 13,14 among them, obesity restricts rib cage mobility and modifies lung volumes during mechanical ventilation, thus increasing EF risk three times. [15][16][17] In Mexico, a combined prevalence of overweight and obesity of 72.5 % was reported in 2016 in 20-year old and older adults. 18 Intensive care unit patients present with anemia of different degrees; those with hemoglobin < 7.5 g/dL have been reported to have twice the risk of EF.…”