Critical Care: Original Investigations in Critical Care |

A Single Center Prospective Observational Study to Assess the Parameters Predicting Extubation Outcome FREE TO VIEW

Alai Taggu, DM; Nui Darang; Bhuvana Krishna, MD
Author and Funding Information

St. Johns Medical College Hospital, Bangalore, India

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):343A. doi:10.1016/j.chest.2016.08.356
Text Size: A A A
Published online

SESSION TITLE: Original Investigations in Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 04:30 PM - 05:30 PM

PURPOSE: Successful weaning and extubation form a vital part of critical care managment. Other than the traditional indices for predicting extubation outcomes like Rapid shallow breathing index, proposed parameters like diaphragm thickness change, fluid balance and cardiac indices have been shown to predict succesful extubation in the recent years. There is a paucity of studies looking at all these important factors at a time to assess the reliablility in predicting extubation success.

METHODS: A prospective observational study done on 220 adult patients eligible for extubation as decided by the attending physicians. Exclusion criteria : Pregnant and tracheostomised patients. Along with baseline parameters, following measurements were taken pre and post extubation. 1.Cardiac parameters including Simpsons method for ejection fraction, E/A, E/e’ (lateral) for diastolic function, TAPSE and TAD for Right ventricular function. All recordings were taken just before extubation and within six hours post extubation. 2.Just before extubation,high frequency linear ultrasound probe was used to measure the right sided DT at the zone of apposition(ZOA) between 8th to 10th intercostal spaces in mid-axillary line.The change in DT fraction(Δdtfrac_pre%) was calculated as DT(end-inspiration)-DT(end-expiration)/DT(end-expiration)x100.RSBI was simultaneously recorded. 3.Fluid balance 24 hours were recorded. Statistics:Logistic regression was used to develop a model with extubation failure as the outcome and change in DT(delta fraction), RSBI, E/e’, E/A , fluid balance 24 hrs and other patient covariates as predictors. Extubation failure was defined as re-intubation within 48 hrs of extubation.

RESULTS: Of the 186 successfully extubated patients, coviartes like diaphragm thickness change ,cardiac parameters (E/e’ , E/A)and fluid balance 24 hrs pre-extubation were statistically significant. But in the logistic model, change in diaphragm thickness was the only significant predictor of extubation success among all covariates (const 8.985, Coef.-0.2715, p value 0.00). A change of > 25% reliably predicted the success.The model showed very good discrimination (receiver operating curve, ROC area of 0.94.4).

CONCLUSIONS: Cardiac dysfunction and fluid balance at 24 hrs before extubation are important parameters to be considered. The change in the diaphragm thickness immdiately before extubation is a good predictor of extubation outcome.

CLINICAL IMPLICATIONS: Weaning induced cardiac dysfunction is an important consideration. PS weaning trial may mask the heart lung interaction leading to cardiac dysfunction. Positive fluid balance contribute significantly to cardiac load and fluid overload state especially with poor cardiac function can lead to re-intubation. Ultrasound is a point of care tool and hence can be readliy used to assess the diaphragmatic thickness change for a successful weaning.

DISCLOSURE: The following authors have nothing to disclose: Alai Taggu, Nui Darang, Bhuvana Krishna

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543