Helena França Correia Dos Reis1, Mansueto Gomes-Neto2, Mônica Lajana Oliveira Almeida3, Mário Ferreira da Silva3, Lorena Barreto Arruda Guedes4, Bruno Prata Martinez5, Mário de Seixas Rocha6. 1. Universidade Federal da Bahia, Salvador, BA, Brazil. Electronic address: helena.correia@ufba.br. 2. Universidade Federal da Bahia, Salvador, BA, Brazil. 3. Hospital Geral do Estado da Bahia, Salvador, BA, Brazil. 4. Universidade do Estado da Bahia, Salvador, BA, Brazil. 5. Universidade Federal da Bahia, Salvador, BA, Brazil; Universidade do Estado da Bahia, Salvador, BA, Brazil. 6. Programa de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
Abstract
PURPOSE: To identify predictors and develop a risk score for the prediction of extubation failure in TBI patients. MATERIALS AND METHODS: We prospectively evaluated 311 TBI adults receiving mechanical ventilation for >48h in the intensive care unit. Epidemiological, ventilatory, airway protective, laboratory, and hemodynamic predictors were evaluated. A multiple logistic regression model was developed to predict the extubation failure risk. A score was developed using the arithmetic sum of the points for each independent predictor, whose scores were proportional to the regression coefficient. The accuracy of the model was determined using the C statistic. RESULTS: Extubation failure occurred in 43 patients (13.8%). Five independent predictors were identified: female sex (4 points) Glasgow Coma Scale motor score≤5 (4 points), moderate-to-large secretion volume (4 points), absent or weak cough (3 points), and mechanical ventilation≥10days (2 points). We calculated the risk score for patients and three risk categories were defined: low (0-3 points), moderate (4-7 points), high (8-17 points). The extubation failure rates in the three groups were 3.5%, 21.2%, and 42.9%, respectively. CONCLUSION: The score developed to predict extubation failure in TBI patients can identify three risk categories and can be easily applied in the ICU.
PURPOSE: To identify predictors and develop a risk score for the prediction of extubation failure in TBIpatients. MATERIALS AND METHODS: We prospectively evaluated 311 TBI adults receiving mechanical ventilation for >48h in the intensive care unit. Epidemiological, ventilatory, airway protective, laboratory, and hemodynamic predictors were evaluated. A multiple logistic regression model was developed to predict the extubation failure risk. A score was developed using the arithmetic sum of the points for each independent predictor, whose scores were proportional to the regression coefficient. The accuracy of the model was determined using the C statistic. RESULTS:Extubation failure occurred in 43 patients (13.8%). Five independent predictors were identified: female sex (4 points) Glasgow Coma Scale motor score≤5 (4 points), moderate-to-large secretion volume (4 points), absent or weak cough (3 points), and mechanical ventilation≥10days (2 points). We calculated the risk score for patients and three risk categories were defined: low (0-3 points), moderate (4-7 points), high (8-17 points). The extubation failure rates in the three groups were 3.5%, 21.2%, and 42.9%, respectively. CONCLUSION: The score developed to predict extubation failure in TBIpatients can identify three risk categories and can be easily applied in the ICU.