Predictors of reintubation in critically Ill patients

Timothy Miu, Aaron M. Joffe, Norbert Yanez, Nita Khandelwal, Armagan H C Dagal, Steven Deem, Miriam Treggiari

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)178-185
Number of pages8
JournalRespiratory Care
Volume59
Issue number2
DOIs
StatePublished - Feb 1 2014
Externally publishedYes

Fingerprint

Critical Illness
Blood Pressure
Logistic Models
Ventilation
Respiration
Tertiary Care Centers
ROC Curve
Decision Making
Cohort Studies
Heart Rate
Hemodynamics
Regression Analysis
Demography
Simplified Acute Physiology Score

Keywords

  • Airway management
  • Clinical prediction model
  • Cohort study
  • Extubation
  • Human
  • ICU
  • Mechanical ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Miu, T., Joffe, A. M., Yanez, N., Khandelwal, N., Dagal, A. H. C., Deem, S., & Treggiari, M. (2014). Predictors of reintubation in critically Ill patients. Respiratory Care, 59(2), 178-185. https://doi.org/10.4187/respcare.02527

Predictors of reintubation in critically Ill patients. / Miu, Timothy; Joffe, Aaron M.; Yanez, Norbert; Khandelwal, Nita; Dagal, Armagan H C; Deem, Steven; Treggiari, Miriam.

In: Respiratory Care, Vol. 59, No. 2, 01.02.2014, p. 178-185.

Research output: Contribution to journalArticle

Miu, T, Joffe, AM, Yanez, N, Khandelwal, N, Dagal, AHC, Deem, S & Treggiari, M 2014, 'Predictors of reintubation in critically Ill patients', Respiratory Care, vol. 59, no. 2, pp. 178-185. https://doi.org/10.4187/respcare.02527
Miu T, Joffe AM, Yanez N, Khandelwal N, Dagal AHC, Deem S et al. Predictors of reintubation in critically Ill patients. Respiratory Care. 2014 Feb 1;59(2):178-185. https://doi.org/10.4187/respcare.02527
Miu, Timothy ; Joffe, Aaron M. ; Yanez, Norbert ; Khandelwal, Nita ; Dagal, Armagan H C ; Deem, Steven ; Treggiari, Miriam. / Predictors of reintubation in critically Ill patients. In: Respiratory Care. 2014 ; Vol. 59, No. 2. pp. 178-185.
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abstract = "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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N2 - 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.

AB - 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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