Nathan Graden, n/a
Medical Student
University of Minnesota, United States
Disclosure information not submitted.
Jackson Penning, n/a
Medical Student
University of Minnesota, United States
Disclosure information not submitted.
Gregory Beilman, MD, FCCM
Senior Vice President Acute Operations
University of Minnesota
Richfield
Disclosure information not submitted.
Title: Failed Extubation: Characterizing High Risk Patients
Introduction: Extubation failure is a common complication of mechanically ventilated ICU patients. Reintubation leads to increased mortality, ventilator associated pneumonia and length of stay in the ICU. While standard weaning protocols exist for extubation, there is no reliable predictor of extubation failure.
Methods: A prospective observational study was performed to correlate patient demographics and clinical parameters with extubation outcomes. The study population included patients that were intubated for greater than 24 hours that did not receive a tracheostomy, were not transferred, and did not die prior to extubation. Univariate sample t-test analysis, chi-square analysis and multivariate principal component analysis were performed to identify factors significantly associated with extubation success or failure.
Results: 37 patients over 4 months were enrolled in the surgical ICU at the University of Minnesota. Six patients (16%) were reintubated within 48 hours. In this pilot study advanced age, tachypnea, and recent head and neck surgery were significantly correlated with increased risk for failed extubation. Many commonly used parameters measuring respiratory status did not predict extubation failure. Failed extubation was associated with increased time on ventilator and prolonged hospital stay.
Conclusions: Respiratory rate, age, and recent head and neck surgery were important predictors of failed extubation in ventilated ICU patients. Rapid shallow breathing index(RSBI), a parameter commonly used to determine extubation readiness, is not a reliable predictor of failed extubation. Reliable prediction and avoidance of failed extubation may reduce patient time in the hospital and on the ventilator.