Predictors of extubation failure in neurosurgical patients
Main Article Content
Keywords
Airway extubation, Mechanical ventilation, Neurosurgical procedures
Abstract
Background: The information regarding the factors that affect the success of extubation in neurosurgical patients is limited; thus, it is necessary to determine the prevalence, and the associated factors, of extubation failure in neurosurgical patients.
Methods: It was performed a prospective, longitudinal, observational and comparative study in neurosurgical patients with criteria for extubation. In those who the number of endotracheal aspirations had failed 24 hours before extubation, it was analyzed the presence of cough reflex, length of stay and mechanical ventilation days.
Results: 70 patients were included in the study, of whom 11.4 % patients failed extubation and the associated factors were performing 6 events or more of endotracheal tube suction 24 hours prior to weaning (relative risk [RR] = 1.88, 95 % confidence interval [CI] = 1.14-3.09, p 0.01), 7 days of mechanical ventilation (RR = 1.31, 95 % CI = 1.08-1.57, p 0.005) and a length of hospital stay of 7.5 days (RR = 1.24, 95 % CI = 1.05-1.47, p 0.01).
Conclusions: performing 6 or more endotracheal tube suction events during the 24 hours before extubation is a risk factor for extubation failure in neurosurgical patients.
References
MacIntyre NR, Cook DJ, Wesley Ely Jr E, Epstein SK, Fink JB, Heffner JE, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support. Chest. 2001;120:375s-95s.
Boles J, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033-56.
Esteban A, Alia I, tobin M, Gil A, Gordo F, Vallverdù I, et al. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1999 Feb;159(2):512-8.
Esteban A, Alía I, Gordo F, Fernandez R, Solsona J, Vallverdú I, et al. Extubation outcome after spontaneous breathing trials with T- tube or pressure support ventilation. Am J Respir Crit Care Med. 1997 Aug;156(2 Pt 1):459-65.
Mascia L, Majorano M. Mechanical ventilation for patients with acute brain injury. Curr Opin Crit Care. 2000;6:52-6.
Namen AM, Ely EW, Tatter SB, Case LD, Lucia MA, Smith A, et al. Predictors of successful extubation in neurosurgical patients. Am J Respir Crit Care Med. 2001;163:658-64.
Tsang JLY, Ferguson ND. Liberation from Mechanical Ventilation in Acutely Brain- Injured Patients. In: Vincent JL (Ed). 2006 Yearbook of Intensive Care and Emergency Medicine. Berlin: Springer-Verlag; 2006.
Ko R, Ramos L, Chalela J. Conventional Weaning Parameters do not Predict Extubation Failure in Neurocritical Care Patients. Neurocrit Care. 2009;10(3):269-73. doi: 10.1007/s12028-008-9181-9.
Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implications of extubation delay in brain injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000 May;161(5):1530-6.
Qureshi AI, Suarez JI, Parekh PD, Bhardwaj A. Prediction and timing of tracheostomy in patients with infratentorial lesion requiring mechanical ventilatory support. Crit Care Med. 2000 May;28(5):1383-7.
Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Mancebo J. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T- piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med. 1998 Dec;158(6):1855-62.
Koh WY, Lew TW, Chin NM, Wong MF. Tracheostomy in neuro-intensive care setting: indications and timing. Anaesth Intensive Care. 1997 Aug;25(4):365-8.
MacIntyre NR, Epstein SK, Carson S, Scheinhorn D, Christopher K, Muldoon S. Managment of patients requiring prolonged mechanical ventilation: Report of a NAMDRC consensus conference. Chest. 2005 Dec;128(6):3937-54.
MacIntyre NR. Respiratory mechanics in the patient who is weaning from the ventilator. Respir Care. 2005 Feb;50(2):275-86; discussion 284-6.
Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest. 2001 Oct;120(4):1262-70.
Kupfer Y, Tessler S. Weaning the difficult patient: the evolution from art to science. Chest. 2001;119:7-9.
Yang KL, Tobin M. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991 May 23;324(21):1445-50.
Tobin MJ, Alex CG. Discontinuation of mechanical ventilation. In: Tobin MJ, editor. Principles and practice of mechanical ventilation. New York: McGraw-Hill; 1994; pp. 1177-1206.
American Thoracic Society/European Respiratory Society (ATS/ERS). Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002 Aug 15;166(4):518-624.