title: Establishing predictors for successfully planned endotracheal extubation.
abstract: The aim of this study was to establish predictors for successfully planned extubation, which can be followed by medical personnel. The patients who were admitted to the adult intensive care unit of a tertiary hospital and met the following criteria between January 2005 and December 2014 were collected retrospectively: intubation > 48 hours; and candidate for extubation. The patient characteristics, including disease severity, rapid shallow breath index (RSBI), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), cuff leak test (CLT) before extubation, and outcome, were recorded. The CLT was classified as 2+ with audible flow without a stethoscope, 1+ with audible flow using a stethoscope, and negative (N) with no audible flow, even with a stethoscope. Failure to extubate was defined as reintubation within 48 hours. In total, 6583 patients were enrolled and 403 patients (6.1%) had extubation failures. Male patients dominated the patient cohort (4261 [64.7%]). The mean age was 64.5±16.3 years. The overall in-hospital mortality rate was 11.3%. The extubation failure rate for females was greater than males (7.7% vs 5.3%, P < 0.001). The group of patients who failed extubation were older (66.7 ± 14.4 vs 64.3 ± 16.4, P = 0.002), had higher APACHE II scores (16.8 ± 7.6 vs 15.9 ± 7.8, P = 0.023), lower coma scales (10.3 ± 3.7 vs 10.8 ± 3.7, P = 0.07), a higher RSBI (69.9 ± 37.3 vs 58.6 ± 30.3, P < 0.001), a lower MIP, and MEP (-35.6 ± 15.3 vs -37.8 ± 14.6, P = 0.0001 and 49.6 ± 28.4 vs 58.6 ± 30.2, P < 0.001, respectively), and a higher mortality rate (25.6% vs 10.5%, P < 0.001) compared to the successful extubation group. Based on multivariate logistic regression, a CLT of 2+ (odds ratio [OR] = 2.07, P < 0.001), a MEP ≥ 55 cmH2O (OR = 1.73, P < 0.001), and a RSBI < 68 breath/min/ml (OR = 1.57, P < 0.001) were independent predictors for successful extubation.This study identified 3 independent risk factors for successful extubation after a successful breathing trial, including a CLT of 2+, a MEP ≥ 55 cmH2O, and a RSBI < 68 breath/min/ml. Furthermore, a nomogram integrating these 3 parameters, which represented the combined consideration of the upper airway patentency, cough strength, and respiratory capacity, was developed to better predict extubation success.
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying Department of Intensive Care Medicine Department of Internal Medicine, Chi Mei Medical Center Department of Chia Nan University of Pharmacy & Science, Tainan Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
authors.forename: Chin-Ming
authors.initials: CM
authors.lastname: Chen
authors.forename: Shyh-Ren
authors.initials: SR
authors.lastname: Chiang
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Liu
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.forename: Mei-I
authors.initials: MI
authors.lastname: Sung
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Hsing
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Cheng
mesh_terms: D000328:Adult; D060666:Airway Extubation / Q000592:standards*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology