INTRODUCTION: Accurate prediction of successful extubation in patients with Guillain-Barré syndrome (GBS) is an important clinical problem. We hypothesized that reversal of clinical indices used to intubate a patient (i.e., declining vital capacity [VC]) predict extubation. METHODS: This was a retrospective study in neurocritical care units at two teaching hospitals identifying all mechanically-ventilated patients with GBS. RESULTS: A total of 44 patients with GBS were included. Of these, 14 patients were successfully extubated. There were 10 failed extubations among six patients; and 20 patients underwent tracheostomy without an extubation trial. On the day of extubation, lower negative inspiratory force (NIF) (-50.3 +/- 12.7 versus -28.6 +/- 16.5 cm H(2)O, p = 0.0005) and higher VC (21.9 +/- 8.4 versus 13.0 +/- 5.9 mL/kg, p = 0.003) correlated with successful extubation. Change in VC preintubation to preextubation by greater than 4 mL/kg correlated with 82% sensitivity and 90% positive predictive value for successful extubation. Failed extubations were associated with the presence of pulmonary comorbidities (79 versus 36%, p = 0.008) and autonomic dysfunction (73 versus 27%, p = 0.008). Length of stay (LOS) in the intensive care unit (ICU) was increased in patients who failed extubation and in those patients who underwent tracheostomy (21.5 +/- 11.1 versus 12.5 +/- 8.7, p = 0.005). In multivariate analysis, higher VC at extubation was associated with successful extubation ( p = 0.05). CONCLUSIONS: In mechanically-ventilated patients with respiratory failure secondary to GBS, NIF less than -50 cm H(2)O, and VC improvement preextubation to preintubation by 4 mL/kg were significantly associated with successful extubation. Failed extubation or need for tracheostomy correlated with autonomic dysfunction, pulmonary comorbidities, and prolonged LOS in the ICU. Such parameters may be helpful in identifying patients with GBS likely to succeed extubation versus early referral for tracheostomy.
INTRODUCTION: Accurate prediction of successful extubation in patients with Guillain-Barré syndrome (GBS) is an important clinical problem. We hypothesized that reversal of clinical indices used to intubate a patient (i.e., declining vital capacity [VC]) predict extubation. METHODS: This was a retrospective study in neurocritical care units at two teaching hospitals identifying all mechanically-ventilated patients with GBS. RESULTS: A total of 44 patients with GBS were included. Of these, 14 patients were successfully extubated. There were 10 failed extubations among six patients; and 20 patients underwent tracheostomy without an extubation trial. On the day of extubation, lower negative inspiratory force (NIF) (-50.3 +/- 12.7 versus -28.6 +/- 16.5 cm H(2)O, p = 0.0005) and higher VC (21.9 +/- 8.4 versus 13.0 +/- 5.9 mL/kg, p = 0.003) correlated with successful extubation. Change in VC preintubation to preextubation by greater than 4 mL/kg correlated with 82% sensitivity and 90% positive predictive value for successful extubation. Failed extubations were associated with the presence of pulmonary comorbidities (79 versus 36%, p = 0.008) and autonomic dysfunction (73 versus 27%, p = 0.008). Length of stay (LOS) in the intensive care unit (ICU) was increased in patients who failed extubation and in those patients who underwent tracheostomy (21.5 +/- 11.1 versus 12.5 +/- 8.7, p = 0.005). In multivariate analysis, higher VC at extubation was associated with successful extubation ( p = 0.05). CONCLUSIONS: In mechanically-ventilated patients with respiratory failure secondary to GBS, NIF less than -50 cm H(2)O, and VC improvement preextubation to preintubation by 4 mL/kg were significantly associated with successful extubation. Failed extubation or need for tracheostomy correlated with autonomic dysfunction, pulmonary comorbidities, and prolonged LOS in the ICU. Such parameters may be helpful in identifying patients with GBS likely to succeed extubation versus early referral for tracheostomy.
Authors: A M Namen; E W Ely; S B Tatter; L D Case; M A Lucia; A Smith; S Landry; J A Wilson; S S Glazier; C L Branch; D L Kelly; D L Bowton; E F Haponik Journal: Am J Respir Crit Care Med Date: 2001-03 Impact factor: 21.405