Central venous saturation is a predictor of reintubation in difficult-to-wean patients.
OBJECTIVE
To evaluate the predictive value of central venous saturation to detect extubation failure in difficult-to-wean patients.


METHODS
Cohort, multicentric, clinical study.


METHODS
Three medical-surgical intensive care units.


METHODS
All difficult-to-wean patients (defined as failure to tolerate the first 2-hr T-tube trial), mechanically ventilated for >48 hrs, were extubated after undergoing a two-step weaning protocol (measurements of predictors followed by a T-tube trial). Extubation failure was defined as the need of reintubation within 48 hrs.


METHODS
The weaning protocol evaluated hemodynamic and ventilation parameters, and arterial and venous gases during mechanical ventilation (immediately before T-tube trial), and at the 30th min of spontaneous breathing trial.


RESULTS
Seventy-three patients were enrolled in the study over a 6-mo period. Reintubation rate was 42.5%. Analysis by logistic regression revealed that central venous saturation was the only variable able to discriminate outcome of extubation. Reduction of central venous saturation by >4.5% was an independent predictor of reintubation, with odds ratio of 49.4 (95% confidence interval 12.1-201.5), a sensitivity of 88%, and a specificity of 95%. Reduction of central venous saturation during spontaneous breathing trial was associated with extubation failure and could reflect the increase of respiratory muscles oxygen consumption.


CONCLUSIONS
Central venous saturation was an early and independent predictor of extubation failure and may be a valuable accurate parameter to be included in weaning protocols of difficult-to-wean patients.
Intensive Care Unit, Moinhos de Vento Hospital, Porto Alegre, Brazil. cassiano.rush@terra.com.br
Cassiano
C
Teixeira
Nilton Brandão
NB
da Silva
Augusto
A
Savi
Silvia Regina Rios
SR
Vieira
Luis Antônio
LA
Nasi
Gilberto
G
Friedman
Roselaine Pinheiro
RP
Oliveira
Ricardo Viegas
RV
Cremonese
Túlio Frederico
TF
Tonietto
Mathias Azevedo Bastian
MA
Bressel
Juçara Gasparetto
JG
Maccari
Ricardo
R
Wickert
Luis Guilherme
LG
Borges
D001784:Blood Gas Analysis; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods
D010100:Oxygen