Development of a predictive model for Extubation Failure in weaning from mechanical ventilation: A retrospective cohort study

• Published in: Trends in anaesthesia & critical care Vol. 17; pp. 21 - 26
• Main Authors: Sará-Ochoa, Jorge Eliécer, Hernández Ortíz, Olga Helena, Jaimes, Fabián Alberto
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-12-2017
• Subjects: Endotracheal intubation; Extubation failure; Intensive care unit; Mechanical ventilation; Respiratory insufficiency; Weaning; Respiratory insufficiency; Weaning; Extubation failure; Mechanical ventilation; Endotracheal intubation; Intensive care unit
• ISSN: 2210-8440
• DOI: 10.1016/j.tacc.2017.10.060

Extubation failure (EF) occurs in 2–25% of ICU patients. Our objective was to develop an EF predictive model.
We performed a retrospective cohort study in a medical-surgical ICU with 40 beds at a University Hospital. Were analyzed 1017 patients, from January 2010 to December 2014, all over 16 years old, undergoing invasive ventilation for more than 24 h, and successful spontaneous breathing test (SBT). Seventeen variables were evaluated; we utilized logistic regression analysis with an evaluation of discrimination and calibration based on the area under the ROC curve (AUC-ROC) and the Hosmer-Lemeshow's goodness-of-fit test (Chi2 H-L), respectively.
Extubation failure was present in 157 patients (15.4%); we developed a predictive model that included PaO2/FIO2 ratio ≤ 237.5, hemoglobin ≤9.5 g, accumulated fluid balance > 6022 ml, APACHE II > 16, blood urea nitrogen > 22.5 mg/dl and the presence of cardiopulmonary diagnostics. This model exhibited an AUC-ROC = 0.689 and a Chi2 H-L, p = 0.579.
This study presents a risk score with an estimated probability of EF based on a multivariate predictive model. Due to the strong limitation of our retrospective study, however, it is necessary for an independent prospective cohort to improve discrimination and to prove the model applicability.
•One hundred fifty seven patients presented Extubation Failure of 1017 (15.4%), 43 (4.2%) were re-intubated and 114 (11.2%) had rescue Noninvasive Ventilation in the last 48 h after extubation.•In both the stepwise algorithm and the backward exclusion procedure, the six best Extubation Failure predictors were PaO2/FIO2 ratio, hemoglobin, APACHE II, accumulated fluid balance, cardiopulmonary diagnostic and BUN.•The study identified a cut-off point through an ROC curve for this predictors: BUN: 22.5 mg/dl, PaO2/FIO2 ratio: 237.5, APACHE II: 16.5, accumulated fluid balance: 6022 ml and hemoglobin: 9.55 gm/dl.•The predictors were become in a respective scores, the final score shows Extubation Failure risk groups according to their probability.•The analysis with a high probability of Extubation Failure (>15%) found a sensitivity of 61%, specificity of 64%, positive predictive value of 23%, negative predictive value of 90% and a positive Likelihood Ratio of 1.71.