Risk factors for extubation failure in patients following a successful spontaneous breathing trial

Chest. 2006 Dec;130(6):1664-71. doi: 10.1378/chest.130.6.1664.

Abstract

Background: To assess the factors associated with reintubation in patients who had successfully passed a spontaneous breathing trial.

Methods: We used logistic regression and recursive partitioning analyses of prospectively collected clinical data from adults admitted to ICUs of 37 hospitals in eight countries, who had undergone invasive mechanical ventilation for > 48 h and were deemed ready for extubation.

Results: Extubation failure occurred in 121 of the 900 patients (13.4%). The logistic regression analysis identified the following associations with reintubation: rapid shallow breathing index (RSBI) [odds ratio (OR), 1.009 per unit; 95% confidence interval (CI), 1.003 to 1.015]; positive fluid balance (OR, 1.70; 95% CI, 1.15 to 2.53); and pneumonia as the reason for initiating mechanical ventilation (OR, 1.77; 95% CI, 1.10 to 2.84). The recursive partitioning analysis allowed the separation of patients into different risk groups for extubation failure: (1) RSBI of > 57 breaths/L/min and positive fluid balance (OR, 3.0; 95% CI, 1.8 to 4.8); (2) RSBI of < 57 breaths/L/min and pneumonia as reason for mechanical ventilation (OR, 2.0; 95% CI, 1.1 to 3.6); (3) RSBI of > 57 breaths/L/min and negative fluid balance (OR, 1.4; 95% CI, 0.8 to 2.5); and (4) RSBI of < 57 breaths/L/min (OR, 1 [reference value]).

Conclusions: Among routinely measured clinical variables, RSBI, positive fluid balance 24 h prior to extubation, and pneumonia at the initiation of ventilation were the best predictors of extubation failure. However, the combined predictive ability of these variables was weak.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Dyspnea / physiopathology
  • Dyspnea / therapy
  • Female
  • Humans
  • Intensive Care Units
  • Intubation, Intratracheal*
  • Logistic Models
  • Male
  • Middle Aged
  • Pneumonia / physiopathology
  • Pneumonia / therapy
  • Positive-Pressure Respiration*
  • Prospective Studies
  • Recurrence
  • Respiration*
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy*
  • Retreatment
  • Risk Factors
  • Ventilator Weaning*
  • Water-Electrolyte Balance / physiology