Early Identification of Extubation Failure Using Integrated Pulmonary Index and High-Risk Factors

• Published in: Respiratory care Vol. 66; no. 10; p. 1542
• Main Authors: Kaur, Ramandeep, Vines, David L, Patel, Ankeet D, Lugo-Robles, Roberta, Balk, Robert A
• Format: Journal Article
• Language: English
• Published: Daedalus Enterprises, Inc 01.10.2021
• Subjects: Health aspects; Medical centers; Medical colleges; Medical research; Medicine, Experimental; Mortality
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.0865

BACKGROUND: Early detection and prevention of extubation failure offers the potential to improve patient outcome. The primary aim of this study was to compare the predictive ability of the Integrated Pulmonary Index and presence of high-risk factors in determining extubation failure. METHODS: A retrospective cross-sectional study of intubated adult subjects receiving mechanical ventilation for > 24 h was conducted at an academic medical center. The primary outcome was extubation failure, defined as the need for re-intubation or rescue noninvasive ventilation within 48 h after planned extubation. RESULTS: Among 216 subjects, 170 (78.7%) were successfully extubated, and 46 (21.3%) failed extubation. Extubation failure group had higher body mass index (26.21 vs 28.5 kg/m (2), P 5 .033), rapid shallow breathing index during spontaneous breathing trial (43 vs 53.5, P 5 .02), and APACHE II score (11.86 vs 15.73, P < .001). Presence of [greater than or equal to] 3 highrisk factors (odds ratio 3.11 [95% CI 1.32-7.31], P 5 .009), APACHE II > 12 on extubation day (odds ratio 2.98 [95% CI 1.22-7.27], P 5 .02), and Integrated Pulmonary Index decrease within 1 h after extubation (odds ratio 7.74 [95% CI 3.45-17.38], P < .001) were independently associated with extubation failure. The failed extubation group had higher ICU mortality (8.8% vs 19.6%; absolute difference 10.7% [95% CI -1.9% to 23.4%], P 5 .040) and hospital mortality (10% vs 22%; absolute difference 16.1% [95% CI 2.2-30%], P 5 .005) compared to the successful group. CONCLUSIONS: Among subjects receiving mechanical ventilation for > 24 h, decreasing Integrated Pulmonary Index within the first hour postextubation was a predictor of extubation failure and was superior to other weaning variables collected in this retrospective study. The presence of [greater than or equal to] 3 high-risk factors was also independently associated with extubation failure. Future clinical studies are required to prospectively test the ability of postextubation Integrated Pulmonary Index monitoring to guide additional interventions designed to reduce re-intubation rates and improve patient outcome. Key words: mechanical ventilation; extubation failure; Integrated Pulmonary Index; extubation outcome.