Predictors of extubation failure in mechanically ventilated patients with chronic obstructive pulmonary disease

Abstract

Background Extubation failure is defined as the need for reinstitution of artificial airway within 48–72 h after planned extubation. It is associated with prolonged ICU and hospital stay and is more liable to serious complications and mortality. Objectives To evaluate the frequency of incidence and predictors of extubation failure in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) and its effect on their outcome. Patients and methods This observational descriptive cross-sectional study was carried out on 150 mechanically ventilated patients with COPD. All patients were assessed regarding the severity of the disease using both acute physiology and chronic health evaluation (APACHE) II and simplified acute physiology score scores and cough strength by white card test, with assessment of the amount of the secretion. All ventilatory parameters were monitored, with more attention given to the following: rapid shallow breathing index, negative inspiratory force (NIF), airway occlusion pressure, and weaning indices. Duration of sedation, complications, length of ICU stay, and also mortality rate were recorded. Results According to outcome of extubation, patients were classified into two basic groups: successfully extubated and failed extubation. Extubation failure occurred in 14.7% of the studied patients. Independent predictors of extubation failure were APACHE II more than 26, NIF less than −19, negative white card, CROP less than 11.5, large amount of secretions, and need for sedation more than 2 days. There were significant increases in the incidence of ventilator-associated pneumonia, mortality, ICU, and hospital stay among reintubated group. Conclusion APACHE II more than 26, NIF less than −19, negative white card, CROP less than 11.5, large amount of secretions, and need for sedation more than 2 days are good predictors of extubation failure in patients with COPD. Extubation failure is associated with more frequent morbidity and mortality.