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Predictors of reintubation in critically ill patients.

Publication ,  Journal Article
Miu, T; Joffe, AM; Yanez, ND; Khandelwal, N; Dagal, AH; Deem, S; Treggiari, MM
Published in: Respir Care
February 2014

BACKGROUND: Assessment of a patient's readiness for removal of the endotracheal tube in the ICU is based on respiratory, airway, and neurological measures. However, nearly 20% of patients require reintubation. We created a prediction model for the need for reintubation, which incorporates variables importantly contributing to extubation failure. METHODS: This was a cohort study of 2,007 endotracheally intubated subjects who required ICU admission at a tertiary care center. Data collection included demographic, hemodynamic, respiratory, and neurological variables preceding extubation. Data were compared between subjects extubated successfully and those who required reintubation, using bivariate logistic regression models, with the binary outcome reintubation and the baseline characteristics as predictors. Multivariable logistic regression analysis with robust variance was used to build the prediction model. RESULTS: Of the 2,007 subjects analyzed, 376 (19%) required reintubation. In the bivariate analysis, admission Simplified Acute Physiology Score II, minute ventilation, breathing frequency, oxygenation, number of prior SBTs, rapid shallow breathing index, airway-secretions suctioning frequency and quantity, heart rate, and diastolic blood pressure differed significantly between the extubation success and failure groups. In the multivariable analysis, higher Simplified Acute Physiology Score II and suctioning frequency were associated with failed extubation. The area under the receiver operating characteristic curve was 0.68 for failure at any time, and 0.71 for failure within 24 hours. However, prior failed SBT, minute ventilation, and diastolic blood pressure were additional independent predictors of failure at any time, whereas oxygenation predicted extubation failure within 24 hours. CONCLUSIONS: A small number of independent variables explains a substantial portion of the variability of extubation failure, and can help identify patients at high risk of needing reintubation. These characteristics should be incorporated in the decision-making process of ICU extubation.

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Published In

Respir Care

DOI

EISSN

1943-3654

Publication Date

February 2014

Volume

59

Issue

2

Start / End Page

178 / 185

Location

United States

Related Subject Headings

  • Risk Factors
  • Retreatment
  • Respiratory System
  • Respiration, Artificial
  • ROC Curve
  • Prognosis
  • Male
  • Logistic Models
  • Intubation, Intratracheal
  • Intensive Care Units
 

Citation

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Miu, T., Joffe, A. M., Yanez, N. D., Khandelwal, N., Dagal, A. H., Deem, S., & Treggiari, M. M. (2014). Predictors of reintubation in critically ill patients. Respir Care, 59(2), 178–185. https://doi.org/10.4187/respcare.02527
Miu, Timothy, Aaron M. Joffe, N David Yanez, Nita Khandelwal, Armagan Hc Dagal, Steven Deem, and Miriam M. Treggiari. “Predictors of reintubation in critically ill patients.Respir Care 59, no. 2 (February 2014): 178–85. https://doi.org/10.4187/respcare.02527.
Miu T, Joffe AM, Yanez ND, Khandelwal N, Dagal AH, Deem S, et al. Predictors of reintubation in critically ill patients. Respir Care. 2014 Feb;59(2):178–85.
Miu, Timothy, et al. “Predictors of reintubation in critically ill patients.Respir Care, vol. 59, no. 2, Feb. 2014, pp. 178–85. Pubmed, doi:10.4187/respcare.02527.
Miu T, Joffe AM, Yanez ND, Khandelwal N, Dagal AH, Deem S, Treggiari MM. Predictors of reintubation in critically ill patients. Respir Care. 2014 Feb;59(2):178–185.

Published In

Respir Care

DOI

EISSN

1943-3654

Publication Date

February 2014

Volume

59

Issue

2

Start / End Page

178 / 185

Location

United States

Related Subject Headings

  • Risk Factors
  • Retreatment
  • Respiratory System
  • Respiration, Artificial
  • ROC Curve
  • Prognosis
  • Male
  • Logistic Models
  • Intubation, Intratracheal
  • Intensive Care Units