Risk factors of extubation failure in patients with invasive mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SHI Dongwei ¹ ,  QU Jieming ² , TONG Chaoyang ¹ , GU Guorong ¹

Department of Emergency Medicine ， Zhongshan Hospital ， Fudan University.Shanghai ， 200032 ， China Corresponding author：QU Jieming，E-mail：jmqu64@yahoo.com.cn;

Corresponding author：

QU Jieming, Email: jmqu64@yahoo.com.cn

Keywords：

Mechanical ventilation; Weaning from mechanical ventilation; Pressure support; Spontaneous breathing trial; Extubation; Rapid shallow breathing index

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Objective To assess the risk factors associated with extubation failure in patients who had successfully passed a spontaneous breathing trial.Methods Patients receiving invasive mechanical ventilation for over 48 h were enrolled in the study，they were admitted into Emergency ICU of Zhongshan Hospital during May 2006 and Oct.2007.A spontaneous breathing trial was conducted by a pressure support of 7 cm H2O for 30 min.Clinical data were prospectively recorded for the patient receiving full ventilatory support before and after the spontaneous breathing trial.Regarding the extubation outcome，patients were divived into extubation success group and extubation failure group.Results A total of 58 patients with a mean（±SD） age of 69.4±12.7 years passed spontaneous breathing trial and were extubated.Extubation failure occurred in 11 patients（19%）.The univariate analysis indicated the following associations with extubation failure：elderly patients（78.1±7.9 years vs 67.4±15.1years，P lt;0.05），higher rapid shallow breathing index（RSBI） value（83±12 breaths·min-1·L-1 vs 68±19 breaths·min-1·L-1，P lt;0.05）and excessive respiratory tract secretions（54.5％ vs 21.3％，P lt;0.05）.Conclusion Among routinely measured clinical variables，elderly patients，higher RSBI value and amount of respiratory tract secretions were the valuable index for predicting extubation failure despite a successful spontaneous breathing trial.

Citation： SHI Dongwei,QU Jieming,TONG Chaoyang,GU Guorong. Risk factors of extubation failure in patients with invasive mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(5): 367-369. doi: Copy

1.	Volta CA，Alvisi V，Marangoni E.Weaning from mechanical ventilation.Curr Anaes Crit Care，2006，17：321-327.
2.	Cohen JD，Shapiro M，Grozovski E，et al.Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure.Crit Care Med，2006，34：682-686.
3.	Hernandez G，Fernandez R，Luzon E，et al.The early phase of the minute ventilation recovery curve predicts extubation failure better than the minute ventilation recovery time.Chest，2007，131：1315-1322.
4.	Ezingeard E，Diconne E，Guyomarc’h S，et al.Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing.Intensive Care Med，2006，32：165-169.
5.	Frutos-Vivar F，Ferguson ND，Esteban A，et al.Risk factors for extubation failure in patients following a successful spontaneous breathing trial.Chest，2006，130：1664-1671.
6.	Khamiees M，Raju P，DeGirolamo A，et al.Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial.Chest，2001，120：1262-1270.
7.	Mokhlesi B，Tulaimat A，Gluckman TJ，et al.Predicting extubation failure after successful completion of a spontaneous breathing trial.Respir Care，2007，52：1710-1717.
8.	Boles JM，Bion J，Connors A，et al.Weaning from mechanical ventilation.Réanimation，2008，17：74-97.
9.	Mehta S，Nelson DL，Klinger JR，et al.Prediction of postextubation work of breathing.Crit Care Med，2000，28：1341-1346.
10.	俞森洋.谈谈无创性正压通气在急性呼吸衰竭救治中的地位.中国呼吸与危重监护杂志，2007，6：221-225.
11.	Nava S，Gregoretti C，Fanfulla F，et al.Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients.Crit Care Med，2005，33：2465-2470.
12.	俞森洋.加强机械通气撤离的研究.中国呼吸与危重监护杂志，2008，7：242-244.

1. Volta CA，Alvisi V，Marangoni E.Weaning from mechanical ventilation.Curr Anaes Crit Care，2006，17：321-327.
2. Cohen JD，Shapiro M，Grozovski E，et al.Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure.Crit Care Med，2006，34：682-686.
3. Hernandez G，Fernandez R，Luzon E，et al.The early phase of the minute ventilation recovery curve predicts extubation failure better than the minute ventilation recovery time.Chest，2007，131：1315-1322.
4. Ezingeard E，Diconne E，Guyomarc’h S，et al.Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing.Intensive Care Med，2006，32：165-169.
5. Frutos-Vivar F，Ferguson ND，Esteban A，et al.Risk factors for extubation failure in patients following a successful spontaneous breathing trial.Chest，2006，130：1664-1671.
6. Khamiees M，Raju P，DeGirolamo A，et al.Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial.Chest，2001，120：1262-1270.
7. Mokhlesi B，Tulaimat A，Gluckman TJ，et al.Predicting extubation failure after successful completion of a spontaneous breathing trial.Respir Care，2007，52：1710-1717.
8. Boles JM，Bion J，Connors A，et al.Weaning from mechanical ventilation.Réanimation，2008，17：74-97.
9. Mehta S，Nelson DL，Klinger JR，et al.Prediction of postextubation work of breathing.Crit Care Med，2000，28：1341-1346.
10. 俞森洋.谈谈无创性正压通气在急性呼吸衰竭救治中的地位.中国呼吸与危重监护杂志，2007，6：221-225.
11. Nava S，Gregoretti C，Fanfulla F，et al.Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients.Crit Care Med，2005，33：2465-2470.
12. 俞森洋.加强机械通气撤离的研究.中国呼吸与危重监护杂志，2008，7：242-244.

Chinese Journal of Respiratory and Critical Care Medicine

Risk factors of extubation failure in patients with invasive mechanical ventilation

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