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

被引:4
|
作者
Abplanalp, Lauren A. [1 ,2 ]
Ionescu, Filip [2 ,4 ]
Calvo-Ayala, Enrique [1 ,2 ]
Yu, Limin [3 ]
Nair, Girish B. [1 ,2 ]
机构
[1] Beaumont Hlth, Div Pulm & Crit Care, Royal Oak, MI 48073 USA
[2] OUWB Sch Med, Rochester, MI 48309 USA
[3] Beaumont Hlth, Dept Pathol, Royal Oak, MI USA
[4] Univ S Florida, Moffitt Canc Ctr, Morsani Med Sch, Tampa, FL USA
关键词
Static respiratory system compliance; Extubation; Mechanical ventilation; Respiratory Failure; Rapid shallow breathing index; VENTILATION; DURATION; PRESSURE; VOLUME; TRIAL; RISK;
D O I
10.1007/s00408-023-00625-7
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
PurposeVentilator 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 MethodsThis 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.ResultsOf 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).ConclusionRC 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.
引用
收藏
页码:309 / 314
页数:6
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