Intra-abdominal pressure for predicating extubation failure in mechanically ventilated patients: it does work

Abstract

IntroductionReducing the extubation failure is vital to the early recovery of patients with mechanical ventilation(MV). We aimed to explore the predictive value of the change of intra-abdominal pressure(ΔIAP) before extubation on the extubation failure in MV patients.Material and methodsPatients undergone MV for more than 24 hours were selected. We used a urodynamic monitor to measure ΔIAP 30 minutes before extubation. The characteristics and prognosis of MV patients were analyzed. Receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of ΔIAP for extubation failure.ResultsA total of 173 MV patients were included. The risks of extubation failure increased with the decrease of ΔIAP. The risk of extubation failure in ΔIAP≤21mmHg group was 5.7 times that of the ΔIAP≥38mmHg group (OR 5.7, 95%CI 1.5-22.0), the risk of extubation failure in ΔIAP 22～37 mmHg group was 3.8 times that of the ΔIAP≥38mmHg group (OR 3.8, 95%CI 1.0-15.3). The area under the curve (AUC) predicted by ΔIAP for extubation failure was 0.721, the cutoff value was 31mmHg with 82.8% sensitivity and 48.6% specificity. There were no significant differences in the duration of MV, length of ICU stay, and death in ICU of the three groups of patients (all P>0.05).ConclusionsThe ΔIAP has good reference value for predicting extubation failure, which is negatively correlated with the risk of extubation failure in patients with MV. For MV patients with ΔIAP≤31mmHg, they may have higher risk of extubation failure, early alert and interventions are highlighted for those patients.