Advanced age and gender are risk factors for extubation failure in adult ICU
DOI:
https://doi.org/10.5585/conssaude.v19n1.16415Keywords:
Intensive Care Unit, Airway Extubation, Respiration, Artificial, WeaningAbstract
Introduction: Failure in the invasive mechanical ventilation (IMV) withdrawal process is associated with adverse outcomes such as high hospital mortality and high costs.
Objective: To know the risk factors for extubation failure in an adult intensive care unit (ICU) undergoing IMV. Secondly, to know the rate of orotracheal reintubation (Re-TOT).
Methods: Prospective, observational study conducted on electronic medical records over a period of 11 consecutive months in an adult ICU. Chi-square or Fischer's Exact tests compared Re-TOT, sex and age groups.
Results: Medical records from 224 adults were analyzed, with a mean age of 61.9 ± 16.9 years and 48.2% male. The main reason for hospitalization was due to acute respiratory failure (33%). Women were susceptible to extubation failure compared to men (21.5% vs. 10%, p = 0.019; respectively), and advanced age. Re-TOT was 31.5%.
Conclusion: Female gender and advanced age were risk factors for extubation failure. Re-TOT was higher than other indexes in the literature.
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Klompas M, Anderson D, Trick W, Babcock H, Kerlin MP, Li L, et al. The preventability of ventilator-associated events: The CDC Prevention Epicenters Wake Up and Breathe Collaborative. Am J Respir Crit Care Med. 2015;191(3):292–301.
Gao F, Yang LH, He HR, Ma XC, Lu J, Zhai YJ, et al. The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: A systematic review and meta-analysis. Hear Lung J Acute Crit Care [Internet]. 2016;45(4):363–71. Available from: http://dx.doi.org/10.1016/j.hrtlng.2016.04.006
Perkins GD, Mistry D, Gates S, Gao F, Snelson C, Hart N, et al. Effect of Protocolized Weaning with Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation from Mechanical Ventilation among Patients with Respiratory Failure: The Breathe Randomized Clinical Trial. JAMA - J Am Med Assoc. 2018;320(18):1881–8.
Amado-Rodríguez L, del Busto C, García-Prieto E, Albaiceta GM. Mechanical ventilation in acute respiratory distress syndrome: The open lung revisited. Med Intensiva [Internet]. 2017;41(9):550–8. Available from: http://dx.doi.org/10.1016/j.medin.2016.12.012
Girard TD, Alhazzani W, Kress JP, Ouellette DR, Schmidt GA, Truwit JD, et al. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from mechanical ventilation in critically ill adults rehabilitation protocols, ventilator liberation protocols, and cuff leak tests. Am J Respir Crit Care Med. 2017;195(1):120–33.
Hayman WR, Leuthner SR, Laventhal NT, Brousseau DC, Lagatta JM. Cost comparison of mechanically ventilated patients across the age span. J Perinatol. 2015;35(12):1020–6.
Zilberberg MD, de Wit M, Shorr AF. Accuracy of previous estimates for adult prolonged acute mechanical ventilation volume in 2020. Crit Care Med [Internet]. 2012 Jan;40(1):18–20. Available from: https://insights.ovid.com/crossref?an=00003246-201201000-00004
Rose L. Strategies for weaning from mechanical ventilation: A state of the art review. Intensive Crit Care Nurs [Internet]. 2015 Aug;31(4):189–95. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0964339715000464
Pu L, Zhu B, Jiang L, Du B, Zhu X, Li A, et al. Weaning critically ill patients from mechanical ventilation: A prospective cohort study. J Crit Care [Internet]. 2015 Aug;30(4):862.e7-862.e13. Available from: https://linkinghub.elsevier.com/retrieve/pii/S088394411500146X
Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review. J Physiother [Internet]. 2015 Jul;61(3):125–34. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1836955315000557
Jeong BH, Ko MG, Nam J, Yoo H, Chung CR, Suh GY, et al. Differences in clinical outcomes according to weaning classifications in medical intensive care units. PLoS One. 2015;10(4):1–13.
Oliveira ABF de, Dias OM, Mello MM, Araújo S, Dragosavac D, Nucci A, et al. Fatores associados à maior mortalidade e tempo de internação prolongado em uma unidade de terapia intensiva de adultos. Rev Bras Ter Intensiva [Internet]. 2010 Sep;22(3):250–6. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2010000300006&lng=pt&nrm=iso&tlng=pt
Danaga AR, Gut AL, Antunes LC de O, Ferreira AL dos A, Yamaguti FA, Christovan JC, et al. Avaliação do desempenho diagnóstico e do valor de corte para o índice de respiração rápida e superficial na predição do insucesso da extubação. J Bras Pneumol [Internet]. 2009 Jun;35(6):541–7. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132009000600007&lng=pt&tlng=pt
van Berkel A, van Lieshout J, Hellegering J, van der Hoeven JG, Pickkers P. Causes of death in intensive care patients with a low APACHE II score. Neth J Med [Internet]. 2012 Dec;70(10):455–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23230015
Louriz M, Abidi K, Akkaoui M, Madani N, Chater K, Belayachi J, et al. Determinants and outcomes associated with decisions to deny or to delay intensive care unit admission in Morocco. Intensive Care Med [Internet]. 2012 May 8;38(5):830–7. Available from: http://link.springer.com/10.1007/s00134-012-2517-0
Souza S da S, Figueiredo LC de, Guedes CAV, Araújo S. Teste de permeabilidade de vias aéreas pré-extubação: comparação entre três métodos em ventilação espontânea. Rev Bras Ter Intensiva [Internet]. 2007 Sep;19(3):310–6. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2007000300007&lng=pt&nrm=iso&tlng=pt
Arcentales A, Caminal P, Diaz I, Benito S, Giraldo BF. Classification of patients undergoing weaning from mechanical ventilation using the coherence between heart rate variability and respiratory flow signal. Physiol Meas [Internet]. 2015 Jul 1;36(7):1439–52. Available from: http://stacks.iop.org/0967-3334/36/i=7/a=1439?key=crossref.dbb8a16c3b5e2f17c76d2d9c5f7ebabe
Reis HFC dos, Almeida MLO, Silva MF da, Moreira JO, Rocha M de S. Association between the rapid shallow breathing index and extubation success in patients with traumatic brain injury. Rev Bras Ter Intensiva [Internet]. 2013;25(3):212–7. Available from: http://www.gnresearch.org/doi/10.5935/0103-507X.20130037
Menon N, Joffe AM, Deem S, Yanez ND, Grabinsky A, Dagal AH, et al. Occurrence and Complications of Tracheal Reintubation in Critically Ill Adults. Respir Care [Internet]. 2012 Oct 1;57(10):1555–63. Available from: http://openurl.ingenta.com/content/xref?genre=article&issn=0020-1324&volume=57&issue=10&spage=1555
Savi A, Teixeira C, Silva JM, Borges LG, Pereira PA, Pinto KB, et al. Weaning predictors do not predict extubation failure in simple-to-wean patients. J Crit Care [Internet]. 2012 Apr;27(2):221.e1-221.e8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0883944111003728
Jordan J, Rose L, Dainty KN, Noyes J, Blackwood B. Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: A qualitative evidence-synthesis. Cochrane Database Syst Rev. 2015;2015(7).
Zhu B, Li Z, Jiang L, Du B, Jiang Q, Wang M, et al. Effect of a quality improvement program on weaning from mechanical ventilation: a cluster randomized trial. Intensive Care Med [Internet]. 2015 Oct 9;41(10):1781–90. Available from: http://link.springer.com/10.1007/s00134-015-3958-z
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