Risk factors for extubation failure in patients following a successful spontaneous breathing trial.
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.
Frutos-Vivar
Fernando
F
Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12,500, 28905 Getafe, Madrid, Spain. ffrutos@ucigetafe.com
Ferguson
Niall D
ND
Esteban
Andrés
A
Epstein
Scott K
SK
Arabi
Yaseen
Y
Apezteguía
Carlos
C
González
Marco
M
Hill
Nicholas S
NS
Nava
Stefano
S
D'Empaire
Gabriel
G
Anzueto
Antonio
A
D000368:Aged; D004417:Dyspnea / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000503:physiopathology / Q000628:therapy; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012008:Recurrence; D012119:Respiration; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D019233:Retreatment; D012307:Risk Factors; D015300:Ventilator Weaning; D014882:Water-Electrolyte Balance / Q000502:physiology