Abstract
BackgroundExtubation failure is associated with mortality and morbidity in the intensive care unit. Ventilator weaning protocols have been introduced, and extubation is conducted based on the results of a spontaneous breathing trial. Room for improvement still exists in extubation management, and additional objective indices may improve the safety of the weaning and extubation process. Static lung-thorax compliance reflects lung expansion difficulty that is caused by several conditions, such as atelectasis, fibrosis, and pleural effusion. Nevertheless, it is not used commonly in the weaning and extubation process. In this study, we investigated whether lung-thorax compliance is a good index of extubation failure in adults even when patients pass a spontaneous breathing trial.MethodsIn a single-center, retrospective cohort study, patients over 18 years of age were mechanically ventilated, weaned with proportional assist ventilation, and underwent a spontaneous breathing trial process in surgical intensive care units of Kagawa University Hospital from July 2014 to June 2016. Extubation failure was the outcome measure of the study. We defined extubation failures as when patients were reintubated or underwent non-invasive positive-pressure ventilation within 24 h after extubation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the clinical involvement of several parameters. The area under the curve (AUC) was calculated to assess the discriminative power of the parameters.ResultsWe analyzed 173 patients and compared the success and failure groups. Most patients (162, 93.6%) were extubated successfully, and extubation failed in 11 patients (6.4%). The averages of lung-thorax compliance values in the success and failure groups were 71.9 ± 23.0 and 43.3 ± 14.6 mL/cmH2O, respectively, and were significantly different (p < 0.0001). In the ROC curve analysis, the AUC was highest for lung-thorax compliance (0.862), followed by the respiratory rate (0.821), rapid shallow breathing index (0.781), Acute Physiology and Chronic Health Evaluation II score (0.72), heart rate (0.715), and tidal volume (0.695).ConclusionsLung-thorax compliance measured during a spontaneous breathing trial is a potential indicator of extubation failure in postoperative patients.
Highlights
Extubation failure is associated with mortality and morbidity in the intensive care unit
Static lung-thorax compliance (LTC), which is calculated by the formula: tidal volume/(pressure measured from the onset of end-inspiratory occlusion − positive end-expiratory pressure) [16,17,18], is a candidate for an index that can help to more safely extubate patients
LTC reflects the difficulty of lung expansion that is caused by several conditions such as atelectasis, fibrosis, pleural effusion, intrapulmonary fluid retention, or a decrease in compliance due to obesity [17,18,19]
Summary
Extubation failure is associated with mortality and morbidity in the intensive care unit. Ventilator weaning protocols have been introduced, and extubation is conducted based on the results of a spontaneous breathing trial. Static lung-thorax compliance reflects lung expansion difficulty that is caused by several conditions, such as atelectasis, fibrosis, and pleural effusion. It is not used commonly in the weaning and extubation process. We investigated whether lung-thorax compliance is a good index of extubation failure in adults even when patients pass a spontaneous breathing trial. LTC reflects the difficulty of lung expansion that is caused by several conditions such as atelectasis, fibrosis, pleural effusion, intrapulmonary fluid retention, or a decrease in compliance due to obesity [17,18,19]. The relationship between LTC during spontaneous breathing and extubation failure is not clear
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