The Outcome and Predictors of Failed Extubation in Intensive Care Patients¡ªThe ?Elderly is an Important Predictor

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• 作者：Ai-Chin Cheng¹ ; ² ; Kuo-Chen Cheng¹ ; ³ ; ⁴ ; ⁵ ; Chin-Ming Chen² ; ⁶ ; ⁷ ; ⁸ ; ^{chencm3383@yahoo.com.tw} ; Shu-Chen Hsing¹ ; Mei-Yi Sung¹
• 关键词：elderly ; endotracheal intubation ; failed extubation ; planned extubation
• 刊名：International Journal of Gerontology
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：5
• 期：4
• 页码：206-211
• 全文大小：493 K

文摘

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Summary

Background

Weaning off the ventilator and removal of the endotracheal tube requires appropriate timing and supportive care in order to avoid reintubation. In this study, the incidence, outcome, and factors predictive of failed extubation (reintubation within 48 hours), as well as the associated mortality in critically ill patients on mechanical ventilation in the adult intensive care unit (ICU), were studied.

Methods

The medical records of all patients who experienced planned extubation in the ICUs of Chi-Mei Medical Center in 2008 were reviewed. The primary endpoints were factors predicting failed extubation and mortality. The secondary endpoint was the outcome of failed extubation.

Results

Among the 1794 patients experiencing planned extubation, 167 patients (9.3 % ) required reintubation within 48 hours. The overall mortality rate was 8.1 % . Using multivariate analyses, the factors predicting failed extubation were age ?5 years and medical patients. The predictors of mortality included age ?5 years, higher Acute Physiology and Chronic Health Evaluation II scores, and failed extubation. The patients with failed extubation had significantly longer ICU and hospital stays (15.2 vs. 6.6 days, and 40.3 vs. 24.0 days, respectively), increased incidence of tracheostomy (21.6 % vs. 1.5 % ), a higher hospital mortality (45.5 % vs. 4.2 % ), and higher hospital costs (52.3 vs. 30.4 ¡Á 10⁴ New Taiwan dollars) when compared with patients who had successful extubation.

Conclusion

Our study indicated that patients with failed extubation experienced significantly increased admission expenditure, increased tracheostomy rate, and higher hospital mortality. Advanced age should be considered an important risk factor for failed extubation and overall mortality when planning extubation in critically ill ICU patients.