Chest
Clinical Investigations in Critical CarePredictors of Extubation Outcome in Patients Who Have Successfully Completed a Spontaneous Breathing Trial
Section snippets
Materials and Methods
The Investigational Review Board of our hospital waived requiring informed consent for this study. Patients in our medical-cardiac ICUs who were receiving mechanical ventilation via an endotracheal tube between April 1999 and February 2000 were assessed when they had successfully completed an SBT and when their caregivers were about to allow them to be extubated. In our ICU, weaning is guided by a nonmandatory protocol that is executed by bedside nurses, respiratory therapists, and resident
Results
Ninety-one patients were followed up over 100 separate extubations. The patients ranged in age from 21 to 90 years (mean ± SE, 65.2 ± 1.6 years; Table 1). They varied in acuity of illness, with ICU admission APACHE II scores of 3 to 35 (mean, 17.7 ± 0.7) and a median duration of intubation of 3 days (mean, 5.0 ± 0.5 days). The most common acute reasons for initial intubation and mechanical ventilation were airway protection (n = 22), including massive GI hemorrhage, drug overdose, stroke, and
Discussion
This study identifies factors of “airway competence,” namely cough strength and quantity of endotracheal secretions, as important predictors of extubation outcome in a cohort of patients who have already successfully completed an SBT. In this group, there is synergism between poor cough strength and abundant endotracheal secretions in predicting extubation failure. In addition, significant anemia (hemoglobin level ≤ 10 g/dL) appears to play an independent role in predicting failure. Traditional
Acknowledgment
The authors are grateful to the Daniell Family Foundation, whose contribution to our critical care research program supported this study in part. Also, we thank the nursing staff and respiratory therapists of the Bridgeport Hospital ICUs for their continued dedication and support of our research efforts.
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Supported by an unrestricted research grant from the Daniell Family Foundation.