Static Respiratory System Compliance as a Predictor of Extubation Failure in Patients with Acute Respiratory Failure

Purpose Ventilator weaning protocols rely in part on objective indices to best predict extubation failure in the critically ill. We investigated static respiratory system compliance (RC) as a predictor of extubation failure, in comparison to extubation readiness using rapid shallow breathing index (RSBI). Material and Methods This was a cross-sectional, multi-institutional study of mechanically ventilated patients admitted between 12/01/2017 and 12/01/2019. All patients older than 18 years with a documented spontaneous breathing trial and extubation trial were included. RC and RSBI were calculated prior to the extubation trial. The primary outcome was extubation failure—defined as need for reintubation within 72 h from time of extubation. Results Of the 2263 patients, 55.8% were males with a mean age of 68 years. The population consisted mostly of Caucasians (73%) and African Americans (20.4%). 274 (12.1%) patients required reintubation within 72 h. On multivariate logistic regression after adjusting for age, sex, body mass index (BMI), admission Sequential Organ Failure Assessment (SOFA) score, number of ventilator days, and the P/F ratio on the day of extubation, RC remained the strongest predictor for extubation failure at 24 h (aOR 1.45; 95% CI 1.00–2.10) and 72 h (aOR 1.58; 95% CI 1.15–2.17). There was no significant association between RSBI and extubation failure at 24 (aOR 1.00; 95% CI 0.99–1.01) or at 72 h (aOR 1.00; 95% CI 0.99–1.01). Conclusion RC measured on the day of extubation is a promising physiological discriminant to potentially risk stratify patients with acute respiratory failure for extubation readiness. We recommend further validation studies in prospective cohorts..

Medienart:

E-Artikel

Erscheinungsjahr:

2023

Erschienen:

2023

Enthalten in:

Zur Gesamtaufnahme - volume:201

Enthalten in:

Lung - 201(2023), 3 vom: Juni, Seite 309-314

Sprache:

Englisch

Beteiligte Personen:

Abplanalp, Lauren A. [VerfasserIn]
Ionescu, Filip [VerfasserIn]
Calvo-Ayala, Enrique [VerfasserIn]
Yu, Limin [VerfasserIn]
Nair, Girish B. [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

Themen:

Extubation
Mechanical ventilation
Rapid shallow breathing index
Respiratory Failure
Static respiratory system compliance

Anmerkungen:

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1007/s00408-023-00625-7

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2143999054

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