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Original Research: CRITICAL CARE MEDICINE |

Risk Factors for Extubation Failure in Patients Following a Successful Spontaneous Breathing Trial*

Fernando Frutos-Vivar, MD; Niall D. Ferguson, MD, MSc; Andrés Esteban, MD, PhD; Scott K. Epstein, MD, FCCP; Yaseen Arabi, MD, FCCP; Carlos Apezteguía, MD; Marco González, MD; Nicholas S. Hill, MD, FCCP; Stefano Nava, MD; Gabriel D’Empaire, MD; Antonio Anzueto, MD
Author and Funding Information

*From the Hospital Universitario de Getafe (Drs. Frutos-Vivar and Esteban), Madrid, Spain; the Department of Medicine (Dr. Ferguson), Division of Respirology, and the Interdepartmental Division of Critical Care Medicine, University Health Network, University of Toronto, Toronto, ON, Canada; the Department of Medicine (Dr. Epstein), Caritas-St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA; King Abdulaziz Medical City (Dr. Arabi), Riyadh, Saudi Arabia; Hospital Profesor Posadas (Dr. Apezteguía), Buenos Aires, Argentina; Hospital General de Medellín (Dr. González), Medellín, Colombia; Pulmonary and Critical Care Division (Dr. Hill), Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, MA; Respiratory Intensive Care Unit (Dr. Nava), Fondazione S. Maugeri, Istituto Scientifico di Pavia, Pavia, Italy; Hospital de Clínicas (Dr. D’Empaire), Caracas, Venezuela; and South Texas Veterans Health Care System (Dr. Anzueto), San Antonio, TX.

Correspondence to: Fernando Frutos-Vivar, MD, Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12,500, 28905 Getafe, Madrid, Spain; e-mail: ffrutos@ucigetafe.com



Chest. 2006;130(6):1664-1671. doi:10.1378/chest.130.6.1664
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Background: To assess the factors associated with reintubation in patients who had successfully passed a spontaneous breathing trial.

Methods: We used logistic regression and recursive partitioning analyses of prospectively collected clinical data from adults admitted to ICUs of 37 hospitals in eight countries, who had undergone invasive mechanical ventilation for > 48 h and were deemed ready for extubation.

Results: Extubation failure occurred in 121 of the 900 patients (13.4%). The logistic regression analysis identified the following associations with reintubation: rapid shallow breathing index (RSBI) [odds ratio (OR), 1.009 per unit; 95% confidence interval (CI), 1.003 to 1.015]; positive fluid balance (OR, 1.70; 95% CI, 1.15 to 2.53); and pneumonia as the reason for initiating mechanical ventilation (OR, 1.77; 95% CI, 1.10 to 2.84). The recursive partitioning analysis allowed the separation of patients into different risk groups for extubation failure: (1) RSBI of > 57 breaths/L/min and positive fluid balance (OR, 3.0; 95% CI, 1.8 to 4.8); (2) RSBI of < 57 breaths/L/min and pneumonia as reason for mechanical ventilation (OR, 2.0; 95% CI, 1.1 to 3.6); (3) RSBI of > 57 breaths/L/min and negative fluid balance (OR, 1.4; 95% CI, 0.8 to 2.5); and (4) RSBI of < 57 breaths/L/min (OR, 1 [reference value]).

Conclusions: Among routinely measured clinical variables, RSBI, positive fluid balance 24 h prior to extubation, and pneumonia at the initiation of ventilation were the best predictors of extubation failure. However, the combined predictive ability of these variables was weak.

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