title: Respiratory failure in chronic obstructive pulmonary disease after extubation: value of expiratory flow limitation and airway occlusion pressure after 0.1 second (P0.1).
abstract: OBJECTIVE
  The aim of this study was to confirm the ability of the airway occlusion pressure after 0.1 second (P0.1) recorded after extubation to define chronic obstructive pulmonary disease (COPD) patients with a high risk of postextubation respiratory failure and to evaluate the role of the expiratory flow limitation (EFL) in these patients.
  
  
  METHODS
  Thirty 5 COPD patients who had been weaned from mechanical ventilation and extubated were included in the study. Expiratory flow limitation by the negative expiratory pressure method and P0.1 were recorded at the first hour of postextubation. We determined whether those patients who developed postextubation respiratory failure (failed extubation group) differed from those who did not (successful extubation group).
  
  
  RESULTS
  Fourteen patients presented a postextubation respiratory failure. Expiratory flow limitation and P0.1 values in the failed extubation group, respectively (61.6% +/- 34.0%; 4.3 +/- 1.7 cm H(2)0) were significantly different (P < .05) from those observed in the successful extubation group, respectively (20.3% +/- 24.6%; 1.8 +/- 0.8 cm H(2)0). P0.1 and EFL would seem to be of use in predicting extubation outcome, respectively (OR 3.66, 95% confidence interval 1.68-7.94; OR 1.04, 95% confidence interval 1.01-1.07). The area under the receiver operating characteristic curve for diagnosing postextubation respiratory failure was 0.84 for EFL and 0.87 for P0.1.
  
  
  CONCLUSIONS
  Bedside evaluation of EFL and P0.1 helps to define COPD patients at high risk for postextubation respiratory failure. Extubation failure in COPD was associated with higher EFL.
authors.affiliation: Département de réanimation médicale, Hôpital Pellegrin Tripode-Bordeaux, Cedex, France. frederic.vargas@chu-bordeaux.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Vargas
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boyer
authors.forename: Hoang Nam
authors.initials: HN
authors.lastname: Bui
authors.forename: Louis Rachid
authors.initials: LR
authors.lastname: Salmi
authors.forename: Hervé
authors.initials: H
authors.lastname: Guenard
authors.forename: Didier
authors.initials: D
authors.lastname: Gruson
authors.forename: Gilles
authors.initials: G
authors.lastname: Hilbert
mesh_terms: D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012131:Respiratory Insufficiency / Q000503:physiopathology*; D015300:Ventilator Weaning