What contributes to extubation failure in the ICU?

In intensive care units (ICU) in low-resource settings, older patient age, moderate to copious secretions, and prolonged mechanical ventilation (MV) appear to increase the risk of extubation failure, a recent study has found.

Researchers conducted a prospective observational analysis of 123 ICU patients who had been under MV for at least 48 hours and could tolerate spontaneous breathing trials. Extubation success or failure was assessed 72 hours after extubation.

Forty-two patients experienced extubation failure. This subgroup was significantly older than the extubation success group (mean age, 46.1 vs 40.7 years; p<0.001) and had a higher proportion of patients older than 60 years of age (61.12 percent vs 38.88 percent; p<0.001). MV duration was likewise longer in the failure group (mean, 11.9 vs 8.79 days; p<0.001).

Multivariable logistic regression analysis confirmed that these factors were significantly indicative of extubation failure.

For instance, patients aged >60 years were more than four times as likely to experience failure than younger counterparts (adjusted odds ratio [OR], 4.157, 95 percent confidence interval [CI], 1.384–12.482; p=0.011). Ventilation duration exceeding 10 days was also a strong correlated, aggravating the likelihood of failure by nearly five times (adjusted OR, 4.772, 95 percent CI, 1.554–14.66; p=0.006).

In addition, patients with moderate to copious secretions saw more than threefold increase in the risk of failure (adjusted OR, 3.483, 95 percent CI, 1.102–11.4; p=0.034).

“Based on our study findings, we recommend that patients with the identified predictors should be considered in the decision-making process of weaning from the mechanical ventilator,” the researchers said.