Meiling Xiao1, Jun Duan1. 1. Department of Respiratory Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China.
Abstract
BACKGROUND: Reintubation is associated with increased hospital mortality. It is necessary to identify risk factors associated with reintubation. METHODS: A prospective observational study was performed in a respiratory intensive care unit. Medical patients who successfully completed a spontaneous breathing trial (SBT) were enrolled. Before extubation, age, gender, vital signs, acute physiology and chronic health evaluation II score, SBT attempts, cough peak flow, arterial blood gas tests and albumin were recorded. RESULTS: We enrolled 139 patients. Of these, 22 (15.8%) patients experienced reintubation within 72 hours after extubation. SBT attempts (odds ratio [OR] = 1.446, 95% confidence interval [CI]: 1.095-1.910), cough peak flow (OR = 0.975, 95% CI: 0.956-0.994) and albumin (OR = 0.847, 95% CI: 0.752-0.954) were independent risk factors for reintubation. In patients with 1, 2 and ≥3 SBT attempts, reintubation rates were 7.3%, 21.1% and 45.8%, respectively (P < .01). In patients with cough peak flow ≤60, 61-89 and ≥90 L/min, reintubation rates were 29.4%, 16.7% and 1.9%, respectively (P < .01). In patients with albumin ≤25, 26-30 and ≥31 g/L, reintubation rates were 32.4%, 11.1% and 9.8%, respectively (P = .01). CONCLUSIONS: Multiple SBT attempts, weak cough and low albumin were associated with increased reintubation in medical patients. This study provides information for clinical practitioners in the consideration of patient extubation.
BACKGROUND: Reintubation is associated with increased hospital mortality. It is necessary to identify risk factors associated with reintubation. METHODS: A prospective observational study was performed in a respiratory intensive care unit. Medical patients who successfully completed a spontaneous breathing trial (SBT) were enrolled. Before extubation, age, gender, vital signs, acute physiology and chronic health evaluation II score, SBT attempts, cough peak flow, arterial blood gas tests and albumin were recorded. RESULTS: We enrolled 139 patients. Of these, 22 (15.8%) patients experienced reintubation within 72 hours after extubation. SBT attempts (odds ratio [OR] = 1.446, 95% confidence interval [CI]: 1.095-1.910), cough peak flow (OR = 0.975, 95% CI: 0.956-0.994) and albumin (OR = 0.847, 95% CI: 0.752-0.954) were independent risk factors for reintubation. In patients with 1, 2 and ≥3 SBT attempts, reintubation rates were 7.3%, 21.1% and 45.8%, respectively (P < .01). In patients with cough peak flow ≤60, 61-89 and ≥90 L/min, reintubation rates were 29.4%, 16.7% and 1.9%, respectively (P < .01). In patients with albumin ≤25, 26-30 and ≥31 g/L, reintubation rates were 32.4%, 11.1% and 9.8%, respectively (P = .01). CONCLUSIONS: Multiple SBT attempts, weak cough and low albumin were associated with increased reintubation in medical patients. This study provides information for clinical practitioners in the consideration of patient extubation.