Establishing predictors for successfully planned endotracheal extubation

Abstract

The aim of this study was to establish predictors for successfully planned extubation, which can be followed by medical personnel. The patients who were admitted to the adult intensive care unit of a tertiary hospital and met the following criteria between January 2005 and December 2014 were collected retrospectively: intubation > 48 hours; and candidate for extubation. The patient characteristics, including disease severity, rapid shallow breath index (RSBI), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), cuff leak test (CLT) before extubation, and outcome, were recorded. The CLT was classified as 2+ with audible flow without a stethoscope, 1+ with audible flow using a stethoscope, and negative (N) with no audible flow, even with a stethoscope. Failure to extubate was defined as reintubation within 48 hours. In total, 6583 patients were enrolled and 403 patients (6.1%) had extubation failures. Male patients dominated the patient cohort (4261 [64.7%]). The mean age was 64.5±16.3 years. The overall in-hospital mortality rate was 11.3%. The extubation failure rate for females was greater than males (7.7% vs 5.3%, P < 0.001). The group of patients who failed extubation were older (66.7 ± 14.4 vs 64.3 ± 16.4, P = 0.002), had higher APACHE II scores (16.8 ± 7.6 vs 15.9 ± 7.8, P = 0.023), lower coma scales (10.3 ± 3.7 vs 10.8 ± 3.7, P = 0.07), a higher RSBI (69.9 ± 37.3 vs 58.6 ± 30.3, P < 0.001), a lower MIP, and MEP (−35.6 ± 15.3 vs −37.8 ± 14.6, P = 0.0001 and 49.6 ± 28.4 vs 58.6 ± 30.2, P < 0.001, respectively), and a higher mortality rate (25.6% vs 10.5%, P < 0.001) compared to the successful extubation group. Based on multivariate logistic regression, a CLT of 2+ (odds ratio [OR] = 2.07, P < 0.001), a MEP ≥ 55 cmH2O (OR = 1.73, P < 0.001), and a RSBI < 68 breath/min/ml (OR = 1.57, P < 0.001) were independent predictors for successful extubation.This study identified 3 independent risk factors for successful extubation after a successful breathing trial, including a CLT of 2+, a MEP ≥ 55 cmH2O, and a RSBI < 68 breath/min/ml. Furthermore, a nomogram integrating these 3 parameters, which represented the combined consideration of the upper airway patentency, cough strength, and respiratory capacity, was developed to better predict extubation success.

Análise da força muscular expiratória e respiração espontânea de indivíduos em ventilação mecânica: estudo transversal

“…The similarity found in the VM was observed in other studies 18,30,32 and may have derived from the sample's tolerance to PSV. As the VM is the product of ATV by RR, the difference was found in those variables that tend to change inversely.…”

“…Individuals with a peak of expiratory flow in cough below 60 L/min were five times more inclined to have unsuccessful extubation and 19 times more inclined to dye at the hospital 35 . There is interest on indexes that predict combined results of WMV and extubation 35,18 . Although the need for ventilatory support and AAW has different etiologies 18 , the expiratory function seems useful in the evaluation of the discontinuity of these two factors and physical weakness.…”

“…There is interest on indexes that predict combined results of WMV and extubation 35,18 . Although the need for ventilatory support and AAW has different etiologies 18 , the expiratory function seems useful in the evaluation of the discontinuity of these two factors and physical weakness.…”

“…Thus, reviews and guidelines do not mention the MEP and the expiratory muscle training 10,12,17 . On the other hand, recently the MEP, the rapid shallow breathing index (RSBI) and the test of airway patency were the only independent predictors of success in 6,583 endotracheal extubation processes 18 .…”

Prolongiertes Weaning

“…konnten bei 125 Verbrennungspatienten in einer prospektiven observationellen Studie zeigen, dass die Kombination der Messung der Häufigkeit der notwendigen Absaugens und des Cough Peak Flow eine hohe Voraussagekraft hat. Lai et al[247] identifizierten bei403 Patienten mit Extubationsversagen als unabhängige Risikofaktoren Cuff-Leak-Test, RSBI und maximalen exspiratorischen Druck.5.3 Beatmungsformen im Weaning5.3.1 Einleitung In der Beatmungsmedizin steht heutzutage eine Vielzahl verschiedener Beatmungsmodi zur Verfügung, die zum Teil auch im prolongierten Weaning eingesetzt werden. Hierbei lassen sich grundsätzlich kontrollierte und assistierte Beatmungsformen unterscheiden, obschon die Übergänge fließend sind.…”