title: Prediction of extubation failure in medical intensive care unit patients.
abstract: OBJECTIVE
  The purpose of this study was to evaluate prediction factors for extubation failure (need for reintubation within 48 hours) in medical intensive care unit patients.
  
  
  METHODS
  Sixty-one patients extubated after mechanical ventilation for more than 48 hours were included in the study. A retrospective analysis of medical records and a prospectively maintained database on respiratory parameters was conducted.
  
  
  RESULTS
  Low serum anion gap (P = .001), low serum anion gap corrected for serum albumin (P = .010), and low arterial partial pressure of oxygen (Pao(2))/fraction of inspired oxygen (Fio(2)) ratio (P = .032) were significantly associated with extubation failure. Binary logistic regression analysis revealed low uncorrected and corrected serum anion gap (P = .006 and P = .025, respectively; odds ratio, 0.59 for both) and low Pao(2)/Fio(2) ratio (P = .038; odds ratio, 0.99) as risk factors for extubation failure. Regarding extubation failure, receiver operating characteristic curve (ROC) analysis demonstrated good predictive capabilities of serum anion gap (ROC area under the curve, 0.835; P = .004; cutoff, 7.7 mEq/L; sensitivity, 70.4%; specificity, 85.7%) and corrected serum anion gap (ROC area under the curve, 0.808; P = .009; cutoff, 8.8 mEq/L; sensitivity, 87.5%; specificity, 71.4%). A significantly higher risk for extubation failure was observed in patients with serum anion gap 5.2 mEq/L or less (relative risk, 8.8; 95% confidence interval, 2.4-32.4; P = .004) and corrected serum anion gap 8.6 mEq/L or less (relative risk, 10.0; 95% confidence interval, 2.2-44.9; P = .004).
  
  
  CONCLUSIONS
  Low preextubation serum anion gap values and low preextubation Pao(2)/Fio(2) ratio might help to predict extubation failure in medical intensive care unit patients.
authors.affiliation: II Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, D-81675 München, Germany. bcs.muc@gmx.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Saugel
authors.forename: Philipp
authors.initials: P
authors.lastname: Rakette
authors.forename: Alexander
authors.initials: A
authors.lastname: Hapfelmeier
authors.forename: Caroline
authors.initials: C
authors.lastname: Schultheiss
authors.forename: Veit
authors.initials: V
authors.lastname: Phillip
authors.forename: Philipp
authors.initials: P
authors.lastname: Thies
authors.forename: Matthias
authors.initials: M
authors.lastname: Treiber
authors.forename: Henrik
authors.initials: H
authors.lastname: Einwächter
authors.forename: Alexander
authors.initials: A
authors.lastname: von Werder
authors.forename: Rudi
authors.initials: R
authors.lastname: Pfab
authors.forename: Florian
authors.initials: F
authors.lastname: Eyer
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
mesh_terms: D000136:Acid-Base Equilibrium; D000368:Aged; D060666:Airway Extubation / Q000379:methods*; D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012709:Serum Albumin; D015300:Ventilator Weaning / Q000379:methods*
chemical_list: D012709:Serum Albumin