Predictors Of Reintubation Research Articles

Peripheral perfusion index as a predictor of reintubation in critically ill surgical patients

PurposeWe aimed to evaluate the ability of the peripheral perfusion index (PPI) to predict reintubation of critically ill surgical patients.MethodsThis prospective observational study included mechanically ventilated adults who were extubated after a successful spontaneous breathing trial (SBT). The patients were followed up for the next 48 h for the need for reintubation. The heart rate, systolic blood pressure, respiratory rate, peripheral arterial oxygen saturation (SpO2), and PPI were measured before-, at the end of SBT, 1 and 2 h postextubation. The primary outcome was the ability of PPI 1 h postextubation to predict reintubation using area under the receiver operating characteristic curve (AUC) analysis. Univariate and multivariate analyses were performed to identify predictors for reintubation.ResultsData from 62 patients were analysed. Reintubation occurred in 12/62 (19%) of the patients. Reintubated patients had higher heart rate and respiratory rate; and lower SpO2 and PPI than successfully weaned patients. The AUC (95%confidence interval) for the ability of PPI at 1 h postextubation to predict reintubation was 0.82 (0.71–0.91) with a negative predictive value of 97%, at a cutoff value of ≤ 2.5. Low PPI and high respiratory rate were the independent predictors for reintubation.ConclusionPPI early after extubation is a useful tool for prediction of reintubation. Low PPI is an independent risk factor for reintubation. A PPI > 2.5, one hour after extubation can confirm successful extubation.

B-lines by lung ultrasound as a predictor of re-intubation in mechanically ventilated patients with heart failure.

There have been few studies on predictors of weaning failure from MV in patients with heart failure (HF). We sought to investigate the predictive value of B-lines measured by lung ultrasound (LUS) on the risk of weaning failure from mechanical ventilation (MV) and in-hospital outcomes. This was a single-center, prospective observational study that included HF patients who were on invasive MV. LUS was performed immediate before ventilator weaning. A positive LUS exam was defined as the observation of two or more regions that had three or more count of B-lines located bilaterally on the thorax. The primary outcome was early MV weaning failure, defined as re-intubation within 72 h. A total of 146 consecutive patients (mean age 70 years; 65.8% male) were enrolled. The total count of B-lines was a median of 10 and correlated with NT-pro-BNP level (r2 = 0.132, p < 0.001). Early weaning failure was significantly higher in the positive LUS group (9 out of 64, 14.1%) than the negative LUS group (2 out of 82, 2.4%) (p = 0.011). The rate of total re-intubation during the hospital stay (p = 0.004), duration of intensive care unit stay (p = 0.004), and hospital stay (p = 0.010) were greater in the positive LUS group. The negative predictive value (NPV) of positive LUS was 97.6% for the primary outcome. B-lines measured by LUS can predict the risk of weaning failure. Considering the high NPV of positive LUS, it may help guide the decision of weaning in patients on invasive MV due to acute decompensated HF.

Lung aeration loss as a predictor of reintubation using lung ultrasound in mechanically ventilated patients

Lung aeration loss as a predictor of reintubation using lung ultrasound in mechanically ventilated patients

Risk Factors for Reintubation Related to Non-Airway Failure After Liver Transplantation in Intensive Care Unit: Observational Study

1Braz J Tranpl■v25 n1■e0222■2022Abstract: The aim of this observational study was to evaluate the risk factors and predictive indexes of reintubation in patients after liver transplantation in the intensive care unit of a university hospital. The time at the intensive care unit, time on mechanical ventilation, use of noninvasive ventilation, ventilator-associated pneumonia, mortality, sequential organ failure assessment scores (SOFA), simplified acute physiology score (SAPS 3), model for end-stage liver disease (MELD), Child-Pugh (CHILD), Acute Physiology and Chronic Health Disease Classification System II (APACHE II), and balance of risk score (BAR) were correlated with reintubation. The following tests were used for the statistical analysis: Kolmogorov-Smirnov, χ2, Student’s t-test, and regression analysis and receiver operating characteristic (ROC) curve. Two hundred and thirty-seven individuals were analyzed. Among them, 38 (16%) were reintubated. The comparative analysis was performed between reintubated and non-reintubated individuals. The variables analyzed – ventilator associated pneumonia, death, mechanical ventilation time, intensive care unit time, noninvasive ventilation use, MELD score, SAPS 3, BAR, and SOFA third days – after liver transplantation were significantly different (p &lt; 0.001). In the multivariate regression analysis, the predictors of reintubation after liver transplantation were ventilator associated pneumonia (odds ratio – OR = 10.6; 95% confidence interval – 95%CI 1.04-108.3; p = 0.04) and BAR (OR = 1.18; 95%CI 1.02-1.36; p = 0.02). The highest ROC curves were SOFA third day, MELD, SAPS 3 and BAR scores through the intersections of the sensitivity and specificity curves &gt; 0.70. High values of the BAR score were considered risk factors for reintubation in this study. SOFA third day showed moderate discriminatory power in predicting reintubation after liver transplantation.

Frequent tracheal suctioning is associated with extubation failure in patients with successful spontaneous breathing trial: a single-center retrospective cohort study

BackgroundExtubation failure, i.e., reintubation in ventilated patients, is a well-known risk factor for mortality and prolonged stay in the intensive care unit (ICU). Although sputum volume is a risk factor, the frequency of tracheal suctioning has not been validated as a predictor of reintubation. We conducted this study to examine whether frequent tracheal suctioning is a risk factor for reintubation.Patients and methodsWe included adult patients who were intubated for > 72 h in the ICU and extubated after completion of spontaneous breathing trial (SBT). We compared the characteristics and weaning-related variables, including the frequency of tracheal suctioning between patients who required reintubation within 24 h after extubation and those who did not, and examined the factors responsible for reintubation.ResultsOf the 400 patients enrolled, reintubation was required in 51 (12.8%). The most common cause of reintubation was difficulty in sputum excretion (66.7%). There were significant differences in sex, proportion of patients with chronic kidney disease, pneumonia, ICU admission type, the length of mechanical ventilation, and ICU stay between patients requiring reintubation and those who did not. Multivariate analysis showed frequent tracheal suction (> once every 2 h) and the length of mechanical ventilation were independent factors for predicting reintubation.ConclusionWe should examine the frequency of tracheal suctioning > once every 2 h in addition to the length of mechanical ventilation before deciding to extubate after completion of SBT in patients intubated for > 72 h in the ICU.

Incidence of Immediate Extubation After Pediatric Cardiac Surgery and Predictors for Reintubation.

The objectives were to assess the incidence of immediate tracheal extubation in the operating room after pediatric cardiac surgery and to investigate predictors for subsequent reintubation. This is a single institutional retrospective study including all patients who had a cardiac operation with cardiopulmonary bypass from 2011 to 2016. Patients who required preoperative ventilator support, postoperative open chest, or mechanical support were excluded. Predictors for reintubation after immediate extubation were analyzed only for patients with stage II palliation for single ventricle physiology. Nine hundred nine qualifying operations were identified. Immediate extubation was performed in 590 (64.9%) operations. A multivariable logistic regression model showed that the identities of anesthesiologist ( P = .0003), year of the operation performed ( P < .001), cardiopulmonary bypass time ( P < .001), and type of operations ( P < .001) were significantly associated with immediate extubation. Reintubation was significantly less frequent in patients with immediate extubation compared to those without (6.1% vs 15.0%; P < .001). A subgroup analysis for stage II palliation showed that reintubation after immediate extubation was significant for younger age (0.42 vs 0.54 years, P = .044), lower Po2/Fio2 and Po2 at the last blood gas analysis (66 vs 98 mm Hg, P = .032 and 39 vs 47 mm Hg, P = .008), and higher inotropic score (2 vs 0, P = .034). A multivariable logistic regression model showed that only inotropic score was significantly associated with reintubation ( P = .018). Immediate extubation in the operating room after pediatric cardiac surgery can be performed in most patients. Inotropic score is a predictor for reintubation in stage II palliation.

Voluntary is better than involuntary cough peak flow for predicting re-intubation after scheduled extubation in cooperative subjects.

In this study, we compared the predictive accuracy of voluntary cough peak flow (V-CPF) and involuntary cough peak flow (IV-CPF) for re-intubation in mechanically ventilated subjects. Endotracheally intubated patients who passed a spontaneous breathing trial and assessment of readiness for extubation were enrolled. Before extubation, V-CPF and IV-CPF were measured. Re-intubation was recorded at 72 h after extubation. A total of 115 extubations in 106 cooperative subjects (including 9 subjects with second extubation) and 5 extubations in 5 uncooperative subjects were recorded. At 72 h, 20 (17.4%) and 1 (25%) instances of re-intubation occurred in cooperative and uncooperative subjects, respectively. In cooperative subjects, those who had been successfully extubated had higher V-CPF than re-intubated subjects (81.3 ± 41.4 vs 51.3 ± 31.7, P = .003). However, rates were not significantly different with IV-CPF (70.9 ± 39.8 vs 55.7 ± 37.9, P = .121). Areas under the curve of the receiver operating characteristic in V-CPF and IV-CPF were 0.743 ± 0.057 and 0.632 ± 0.069 (P < .001 and P = .058, respectively, compared with area under the curve = 0.5). V-CPF had higher predictive accuracy for re-intubation than IV-CPF (P = .034). In subjects with a lower quartile and third quartile V-CPF (≤ 43.2 L/min and 43.2-68.4 L/min, respectively), V-CPF was similar to IV-CPF. However, in second quartile and upper quartile V-CPF (68.4-99.0 L/min and > 99.0 L/min, respectively), V-CPF was higher than IV-CPF (82.1 ± 9.6 vs 66.6 ± 19.5 L/min, P < .001; 135.5 ± 29.8 vs 116.2 ± 38.2 L/min, P = .006, respectively). Overall, V-CPF was higher than IV-CPF (76.0 ± 41.4 vs 68.2 ± 39.7, P = .003). In uncooperative subjects, the IV-CPF was higher than V-CPF (40.2 ± 10.2 vs 79.2 ± 29.0, P = .042). V-CPF is noninvasive. It is much more accurate than IV-CPF as a predictor of re-intubation in cooperative patients because the IV-CPF may underestimate cough strength in patients with high V-CPF. However, it is unclear which is optimal for use in uncooperative patients.

Predictive Factors for Reintubation following Noninvasive Ventilation in Patients with Respiratory Complications after Living Donor Liver Transplantation

BackgroundPostoperative respiratory complications are a major cause of mortality following liver transplantation (LT). Noninvasive ventilation (NIV) appears to be effective for respiratory complications in patients undergoing solid organ transplantation; however, mortality has been high in patients who experienced reintubation in spite of NIV therapy. The predictors of reintubation following NIV therapy after LT are not exactly known.MethodsOf 511 adult patients who received living-donor LT, data on the 179 who were treated by NIV were retrospectively examined.ResultsForty-three (24%) of the 179 patients who received NIV treatment required reintubation. Independent factors associated with reintubation by multivariate logistic regression analysis were controlled preoperative infections (odds ratio [OR] 8.88; 95% confidence interval (CI) 1.64 to 48.11; p = 0.01), ABO-incompatibility (OR 4.49; 95% CI, 1.50 to 13.38; p = 0.007), and presence of postoperative pneumonia at the time of starting NIV (OR 3.28; 95% CI, 1.02 to 11.01; p = 0.04). The reintubated patients had a significant higher rate of postoperative infectious complications and a significantly longer intensive care unit stay than those in whom NIV was successful (p<0.0001). Of the 43 reintubated patients, 22 (51.2%) died during hospitalization following LT vs. 8 (5.9%) of the 136 patients in whom NIV was successful (p<0.0001).ConclusionsBecause controlled preoperative infection, ABO-incompatibility or pneumonia prior to the start of NIV were independent risk factors for reintubation following NIV, caution should be used in applying NIV in patients with these conditions considering the high rate of mortality in patients requiring reintubation following NIV.

Predictors of Reintubation in Critically Ill Patients

Assessment of a patient's readiness for removal of the endotracheal tube in the ICU is based on respiratory, airway, and neurological measures. However, nearly 20% of patients require reintubation. We created a prediction model for the need for reintubation, which incorporates variables importantly contributing to extubation failure. This was a cohort study of 2,007 endotracheally intubated subjects who required ICU admission at a tertiary care center. Data collection included demographic, hemodynamic, respiratory, and neurological variables preceding extubation. Data were compared between subjects extubated successfully and those who required reintubation, using bivariate logistic regression models, with the binary outcome reintubation and the baseline characteristics as predictors. Multivariable logistic regression analysis with robust variance was used to build the prediction model. Of the 2,007 subjects analyzed, 376 (19%) required reintubation. In the bivariate analysis, admission Simplified Acute Physiology Score II, minute ventilation, breathing frequency, oxygenation, number of prior SBTs, rapid shallow breathing index, airway-secretions suctioning frequency and quantity, heart rate, and diastolic blood pressure differed significantly between the extubation success and failure groups. In the multivariable analysis, higher Simplified Acute Physiology Score II and suctioning frequency were associated with failed extubation. The area under the receiver operating characteristic curve was 0.68 for failure at any time, and 0.71 for failure within 24 hours. However, prior failed SBT, minute ventilation, and diastolic blood pressure were additional independent predictors of failure at any time, whereas oxygenation predicted extubation failure within 24 hours. A small number of independent variables explains a substantial portion of the variability of extubation failure, and can help identify patients at high risk of needing reintubation. These characteristics should be incorporated in the decision-making process of ICU extubation.

Clinical predictors for reintubation after cardiac surgery

Clinical predictors for reintubation after cardiac surgery

Do steroids prevent reintubation in children with laryngotracheobronchitis?

Classic laryngotrachoebronchitis (LTB) is an inflammatory process, with oedema and secretions that involve the entire laryngotracheobronchial tree. The severity of lower airway disease in African children with LTB has previously been documented. The aim of the present study was to determine whether steroids prevent reintubation in African children with classic LTB. The study was a retrospective analysis from January 1993 to December 1996. Eighty-two black children with LTB were mechanically ventilated in the intensive care unit (ICU). By univariate regression, the estimated B coefficients for variables such as age, pneumonia, days of intubation, arterial partial oxygen tension (PaO2) : fractional inspired oxygen (FIO2) ratio, atelectasis and antibiotic use were not statistically significant (P > 0.05) as predictors for reintubation. Using multiple regression (all independent variables in combination), none of the variables acted as predictors of reintubation (P = 0.25). Steroids were shown to have no effect alone or in association with other variables in altering reintubation rates. An increase in the days of intubation showed a tendency towards reintubation (P = 0.06) in the univariate analysis (odds ratio 1.00-1.14), but showed no statistically significant difference in multivariate analysis. Of the variables used as predictors of reintubation, none acted either as a preventive factor or as a risk factor. The present results suggest that steroids should not be recommended at any stage in treatment of intubated patients with classic LTB. Prospective studies should evaluate the major risk factors for reintubation: duration of intubation, trauma to the airway at intubation and during ICU stay, and dose and timing of steroids. They should also evaluate whether upper airway disease is present alone or in association with lower airway disease.

Unplanned Extubation

Study objective To examine the incidence, clinical impact, and predictors of reintubation following unplanned extubation (UE) in ICU patients. Design Retrospective data collection of prospectively identified consecutive cases of UE. Setting The adult Medical, Coronary, Surgical, Cardiac Surgery, and Neuroscience ICUs of a University Medical Center. Patients Eighty-one episodes of UE in 72 adolescent or adult (53±19 years) ICU patients. Measurements and results In 39 (48 percent) of 81 cases, reintubation was performed within 24 h of UE, 33 (85 percent) within the first hour, and 31 (79 percent) as a result of respiratory distress. There were five documented complications of UE and/or reintubation but no deaths. Clinical predictors for reintubation were sought from routinely available demographic, clinical, laboratory, and respiratory factors which had been documented in the medical records for the 24 h period prior to UE. Using univariate analysis followed by stepwise logistic regression in the first 56 cases (model set), the following factors were identified as being associated with reintubation: (1) volume controlled ventilation (synchronous intermittent mandatory ventilation or assist-control ventilation) with rate more than 6/min; (2) most recent arterial pH level prior to UE being 7.45 or more; (3) most recent ratio of PaO 2 to fraction of inspired oxygen prior to UE less than 250 mm Hg; (4) highest heart rate in the 24 h prior to UE greater than 120 beats per minute; (5) presence of 3 or more coexisting medical disorders (of 7 possible); (6) mental status other than alert; and (7) indication for intubation other than “preoperative.” In the model set, the presence of 4 or more of these 7 factors correctly predicted reintubation in 23 of 25 (92 percent positive predictive value) and presence of 3 or fewer factors correctly predicted no reintubation in 26 of 31 cases (83 percent negative predictive value), with outcome of 88 percent of cases being correctly predicted. The model was tested in the next 24 cases (validation set) in which 18 (75 percent) were correctly predicted. Conclusion Unplanned extubation can result in serious complications; however, about half the patients who have UE can be safely observed without immediate reintubation. Selected clinical factors, which are readily available from standard ICU records for the 24-h period prior to UE, may be useful to predict the likelihood of reintubation.

Unplanned Extubation: Clinical Predictors for Reintubation

To examine the incidence, clinical impact, and predictors of reintubation following unplanned extubation (UE) in ICU patients. Retrospective data collection of prospectively identified consecutive cases of UE. The adult Medical, Coronary, Surgical, Cardiac Surgery, and Neuroscience ICUs of a University Medical Center. Eighty-one episodes of UE in 72 adolescent or adult (53 +/- 19 years) ICU patients. In 39 (48 percent) of 81 cases, reintubation was performed within 24 h of UE, 33 (85 percent) within the first hour, and 31 (79 percent) as a result of respiratory distress. There were five documented complications of UE and/or reintubation but no deaths. Clinical predictors for reintubation were sought from routinely available demographic, clinical, laboratory, and respiratory factors which had been documented in the medical records for the 24 h period prior to UE. Using univariate analysis followed by stepwise logistic regression in the first 56 cases (model set), the following factors were identified as being associated with reintubation: (1) volume controlled ventilation (synchronous intermittent mandatory ventilation or assist-control ventilation) with rate more than 6/min; (2) most recent arterial pH level prior to UE being 7.45 or more; (3) most recent ratio of PaO2 to fraction of inspired oxygen prior to UE less than 250 mm Hg; (4) highest heart rate in the 24 h prior to UE greater than 120 beats per minute; (5) presence of 3 or more coexisting medical disorders (of 7 possible); (6) mental status other than alert; and (7) indication for intubation other than "preoperative." In the model set, the presence of 4 or more of these 7 factors correctly predicted reintubation in 23 of 25 (92 percent positive predictive value) and presence of 3 or fewer factors correctly predicted no reintubation in 26 of 31 cases (83 percent negative predictive value), with outcome of 88 percent of cases being correctly predicted. The model was tested in the next 24 cases (validation set) in which 18 (75 percent) were correctly predicted. Unplanned extubation can result in serious complications; however, about half the patients who have UE can be safely observed without immediate reintubation. Selected clinical factors, which are readily available from standard ICU records for the 24-h period prior to UE, may be useful to predict the likelihood of reintubation.