Abstract
We investigated failure predictors for the planned extubation of overweight (body mass index [BMI] = 25.0–29.9) and obese (BMI ≥ 30) patients. All patients admitted to the adult intensive care unit (ICU) of a tertiary hospital in Taiwan were identified. They had all undergone endotracheal intubation for > 48 h and were candidates for extubation. During the study, 595 patients (overweight = 458 [77%]); obese = 137 [23%]) with planned extubation after weaning were included in the analysis; extubation failed in 34 patients (5.7%). Their mean BMI was 28.5 ± 3.8. Only BMI and age were significantly different between overweight and obese patients. The mortality rate for ICU patients was 0.8%, and 2.9% for inpatients during days 1–28; the overall in-hospital mortality rate was 8.4%. Failed Extubation group patients were significantly older, had more end-stage renal disease (ESRD), more cardiovascular system-related respiratory failure, higher maximal inspiratory pressure (MIP), lower maximal expiratory pressure (MEP), higher blood urea nitrogen, and higher ICU- and 28-day mortality rates than did the Successful Extubation group. Multivariate logistic regression showed that cardiovascular-related respiratory failure (odds ratio [OR]: 2.60; 95% [confidence interval] CI: 1.16–5.80), ESRD (OR: 14.00; 95% CI: 6.25–31.35), and MIP levels (OR: 0.94; 95% CI: 0.90–0.97) were associated with extubation failure. We conclude that the extubation failure risk in overweight and obese patients was associated with cardiovascular system-related respiratory failure, ESRD, and low MIP levels.
Highlights
The prevalence of obesity is increasing worldwide and it has become a global public health threat
All patients who required an invasive mechanical ventilation (MV) using an endotracheal tube for 48 hours and who were prepared for a scheduled extubation according to a weaning protocol and physicians’ judgment between January 2010 and December 2011 were eligible for inclusion
We enrolled 1934 patients who had been scheduled for a first-time extubation after more than 48 h of invasive MV after we had excluded eight patients without available Body mass index (BMI) data (S1 File)
Summary
The prevalence of obesity is increasing worldwide and it has become a global public health threat. Failed extubation of overweight and obese patients the intensive care unit (ICU) for critical care, and ICUs will inevitably have to treat a greater number of critically ill obese patients [8, 9]. Acute respiratory failure is one of the most frequent reasons that patients are transferred to the ICU. This condition is usually treated using endotracheal intubation with invasive mechanical ventilation, regardless of whether the patient is obese or normal weight [10,11,12]. A patient who has survived an acute condition that requires intubation must first be weaned from invasive ventilation. We aimed to determine what would predict the successful extubation of overweight and obese patients
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