Outcome of Prophylactic Noninvasive Ventilation Following Planned Extubation in High-risk Patients: A Two-year Prospective Observational Study from a General Intensive Care Unit

Fatores associados à falha de extubação em unidade de terapia intensiva: estudo de caso-controle

Resumo Objetivo: investigar os fatores associados à falha de extubação de pacientes na unidade de terapia intensiva. Método: caso-controle não pareado, longitudinal, retrospectivo e quantitativo com a participação de 480 pacientes por meio de parâmetros clínicos para desmame ventilatório. Dados analisados por: Teste Exato de Fisher ou o teste Qui-quadrado; teste t de Student bicaudal não pareado; e teste de Mann-Whitney. Admitiram-se significantes valores de P menores ou iguais a 0,05. Resultados: dos pacientes, 415 (86,5%) tiveram sucesso e 65 (13,5%) falharam. Grupo sucesso: balanço hídrico mais negativo, APACHE II em 20 (14-25), tosse fraca em 58 (13,9%). Grupo falha: balanço hídrico mais positivo, APACHE II em 23 (19-29), tosse fraca em 31 (47,7 %), quantidade abundante de secreção pulmonar em 47,7 %. Conclusão: o balanço hídrico positivo e a presença de tosse ineficiente ou incapacidade de higienizar a via aérea foram preditores de falhas de extubação.

Factors associated with extubation failure in an intensive care unit: a case-control study

Abstract Objective: to investigate the factors associated with extubation failure of patients in the intensive care unit. Method: unpaired, longitudinal, retrospective and quantitative case-control with the participation of 480 patients through clinical parameters for ventilator weaning. Data were analyzed by: Fisher’s exact test or the chi-square test; unpaired two-tailed Student’s t test; and Mann-Whitney test. Significant P values lower than or equal to 0.05 were admitted. Results: of the patients, 415 (86.5%) were successful and 65 (13.5%) failed. Success group: the most negative fluid balance, APACHE II in 20 (14-25), weak cough in 58 (13.9%). Failure group: the most positive fluid balance, APACHE II in 23 (19-29), weak cough in 31 (47.7%), abundant amount of pulmonary secretions in 47.7%. Conclusion: positive fluid balance and the presence of inefficient cough or inability to clear the airway were predictors of extubation failure.

Factores asociados al fracaso de la extubación en unidad de cuidados intensivos: estudio de caso y control

Resumen Objetivo: investigar los factores asociados al fracaso de la extubación de pacientes en la unidad de cuidados intensivos. Método: caso y control no apareado, longitudinal, retrospectivo y cuantitativo con la participación de 480 pacientes mediante parámetros clínicos para el destete de la ventilación. Datos analizados por: Prueba Exacta de Fisher o prueba de Chi-cuadrado; prueba t de Student de dos colas para datos no apareados; y prueba de Mann-Whitney. Se admitieron valores de P significativos menores o iguales a 0,05. Resultados: de los pacientes, 415 (86,5%) tuvieron éxito y 65 (13,5%) fracasaron. Grupo de éxito: balance hídrico más negativo, APACHE II en 20 (14-25), tos débil en 58 (13,9%). Grupo de fracaso: balance de líquidos más positivo, APACHE II en 23 (19-29), tos débil en 31 (47,7%), abundante cantidad de secreciones pulmonares en 47,7%. Conclusión: el balance hídrico positivo y la presencia de tos ineficaz o incapacidad para higienizar la vía aérea fueron predictores de fracaso de la extubación.

Impact of Prophylactic Noninvasive Ventilation on Extubation Outcome: A 4-year Prospective Observational Study from a Multidisciplinary ICU

Introduction

With emerging evidence supporting other interventions, there is a need to re-examine the safety and efficacy of postextubation noninvasive ventilation (NIV) support in high-risk patients.

Methods

Data were collected over 4-year period from a multispeciality ICU. High-risk criteria were uniform, and the application of NIV was protocolized. Successful extubation was defined as the absence of both reintubation and NIV support at 72 hours postextubation.

Results

Extubation success was achieved in 79.6%. At extubation, more patients in the failure group had chronic neurological or kidney diseases, longer days of invasive ventilation, higher sequential organ failure assessment score, and more positive fluid balance. Significant differences were also observed in the indications for prophylactic NIV between the two groups. However, in logistic regression analysis, none of these differences observed in univariate analysis was independently associated with extubation outcome. Failure of postextubation NIV was associated with higher hospital mortality (67.7 vs 10.7%, p <0.001) and longer ICU/hospital length of stay (median 10 vs 6 days, p <0.001 and 13 vs 10 days, p <0.01, respectively). No differences were observed in extubation outcomes between 2016 to 2017 and 2018 to 2019 cohorts.

Conclusion

High rate of extubation failure and worse patient-centric outcomes associated with prophylactic NIV calls for a relook into the current recommendation of NIV for this indication.

How to cite this article

Ghosh S, Ghosh S, Singh A, Salhotra R. Impact of Prophylactic Noninvasive Ventilation on Extubation Outcome: A 4-year Prospective Observational Study from a Multidisciplinary ICU. Indian J Crit Care Med 2021;25(6):709–714.