Clinical outcomes associated with high, intermediate, and low rates of failed extubation in an intensive care unit.
OBJECTIVE
Extubation failure is associated with adverse outcomes in mechanically ventilated patients, and it is believed that high rates of failed planned extubation (FPE) should be avoided. However, many believe that very low rates may also correlate with adverse outcomes if resulting from overly conservative weaning practices. We examined the relationship between the percentage of FPE (%FPE) and associated outcomes, with the aim of elucidating a favorable middle range.


METHODS
A total of 1395 extubations were analyzed in mechanically ventilated subjects. Monthly %FPE values were separated into tertiles. Ventilator-free days (VFDs), intensive care unit-free days (IFDs), and mortality were compared among tertiles.


RESULTS
Monthly %FPE tertiles were as follows: low, less than 7%; intermediate, 7% to 15%; and high, greater than 15%. There were significant differences in VFDs and IFDs by tertile from low to high (VFDs: low, 11.8; intermediate, 12.1; high, 9.9 [P = .003]; IFDs: low, 10.5; intermediate, 10.7; high, 9.0 [P = .033]). Post hoc comparisons demonstrated significant differences between the middle and high tertiles for both VFDs and IFDs.


CONCLUSIONS
Although exact rates may vary depending on setting, this suggests that a high %FPE (>15) should be avoided in the intensive care unit and that there may be an intermediate range where ventilator outcomes are optimized.
Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA. Electronic address: skap@uw.edu.
Siddhartha G
SG
Kapnadak
Division of Pulmonary and Critical Care Medicine, University of Virginia Health System, Charlottesville, VA. Electronic address: steveherndon7@hotmail.com.
Steve E
SE
Herndon
Division of Pulmonary and Critical Care Medicine, University of Virginia Health System, Charlottesville, VA. Electronic address: smb4h@virginia.edu.
Suzanne M
SM
Burns
Division of Pulmonary and Critical Care Medicine, University of Virginia Health System, Charlottesville, VA. Electronic address: yss6n@hscmail.mcc.virginia.edu.
Y Michael
YM
Shim
Division of Pulmonary and Critical Care Medicine, University of Virginia Health System, Charlottesville, VA. Electronic address: KE4Z@hscmail.mcc.virginia.edu.
Kyle
K
Enfield
Division of Pulmonary and Critical Care Medicine, University of Virginia Health System, Charlottesville, VA. Electronic address: CB5AM@hscmail.mcc.virginia.edu.
Cynthia
C
Brown
Division of Pulmonary and Critical Care Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI. Electronic address: Jonathon.Truwit@froedtert.com.
Jonathon D
JD
Truwit
Division of Pulmonary and Critical Care Medicine, Georgetown University, Pasquerilla Healthcare Center, Washington, DC. Electronic address: vinayak@gunet.georgetown.edu.
Ajeet G
AG
Vinayak
D000328:Adult; D000368:Aged; D060666:Airway Extubation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D015300:Ventilator Weaning / Q000706:statistics & numerical data*
Critically ill; Extubation failure; Extubation guidelines; Mechanical ventilation; Ventilator weaning