Clinical features and outcome of patients with extubation failure

Introduction

The need for reintubation within 24–72 hours of planned extubation is an event occurring in 2–25% of extubated patients [1]. Developing predictive tools and optimizing extubation decisions require knowledge of the risk factors and clinical features of patients with extubation failure (EF).

Methods

We studied all patients who were intubated and mechanically ventilated in a polyvalent intensive care unit (ICU) during a 12-month period. The following data were collected: age, sex, SAPS II on admission, Glasgow Coma Score (GCS) on day of extubation, length of mechanical ventilation (MV), length of ICU stay (LOS), ICU and hospital mortality. Patients who need reintubation after successful trial of weaning and planned extubation were identified (EF). We considered two parameters that assess airway patency and protection like predictors of EF: cough strength and suctioning frequency. Parameters were analysed using Student's t test (P < 0.05).

Results

Six hundred and sixty-five patients were admitted to the ICU during the study period; 511 of them (76.8%) underwent intubation and MV. Twenty-three patients (4.5%) (17 men and six women) needed reintubation. EF occurred in seven elective surgery, seven emergency surgery, eight medical and one trauma patient. Causes of EF were: inability to manage respiratory secretions (9/23, 39.1%), surgical complications (9/23, 39.1%), severe alteration in consciousness (3/23, 13.2%), pulmonary embolism (1/23, 4.3%) and septic shock (1/23, 4.3%). Significant differences regarding age (72.2 ± 10.8 vs 65 ± 16, P < 0.05) and SAPS II (45 ± 12.7 vs 34 ± 13.1, P < 0.05) were found between EF patients and the others with extubation successful. The value of GCS was similar (14 ± 2.5 vs 13.8 ± 3.1, NS). EF patients have a longer period of MV (11 ± 15.8 vs 4 ± 8.9, P < 0.05) and LOS (23 ± 24.3 vs 6.6 ± 11, P < 0.05); they even have greater ICU and hospital mortality (39.1% vs 9.9% and 47.8% vs 16%). Seven EF patients (30%) needed at least one suctioning every 2 hours after extubation; moreover almost one-half of the patients (10/23, 43.3%) had a weak cough.

Conclusion

Clinical features associated with EF include age, severity of illness and being a medical patient. EF increases the length of VM and LOS and is associated with a higher mortality. Most of EF is unable to protect the airway, a cause of weak cough and abundant secretions; moreover, during the trial of extubation, it is also important to consider the ability to cough and to clear respiratory secretions.