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2026, Number 3

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Med Crit 2026; 40 (3)

Ventilatory ratio in patients operated on cardiothoracic surgery with and without extubation failure

García OM, Rodríguez VJM, Morales BLE, García CF, Landa VDB, Ramírez LE

Language: Spanish
References: 26
Page: 188-196
PDF size: 729.10 Kb.


ABSTRACT

Introduction: extubation in patients on invasive mechanical ventilation (IMV) is common in the intensive care unit (ICU), but it still has considerable failure rates. The ventilatory ratio (VR), an index used to assess ventilatory efficiency in acute respiratory distress syndrome (ARDS), has been underutilized to predict extubation failure in post-cardiothoracic surgery patients. Objective: to compare the ventilatory ratio in patients with and without extubation failure. Material and methods: a descriptive, observational, comparative, cross-sectional, single-center, prospective, homogeneous study was conducted in patients aged >18 years undergoing cardiothoracic surgery. Patients with accidental extubation and tracheostomy were excluded. The RV was calculated using the formula RV = [measured Ve (mL/min) × PaCO2]/(100 × predicted weight × 37.5), and the differences between patients with and without extubation failure were evaluated. Means, medians, frequencies, percentages, and minimum and maximum values were used for the descriptive analysis. The Mann-Whitney U test was used to compare RV means, and the chi-square test (χ2) was used for categorical variables. We analyzed RV performance with ROC curve and mortality with Kaplan-Meier curve and a statistically significant result was taken at p value < 0.05. Results: a total of 115 patients with a median age of 57 (18-82) years were analyzed. We found that being female (p = 0.039), short stature (p = 0.001), low predicted weight (p = 0.001), hypothyroidism (p = 0.030), and suboptimal doses of milrinone (p = 0.002) favor extubation failure. Also, a high tidal volume (p = 0.003) and high minute volume (p < 0.001) decrease the percentage of successful weaning. We obtained differences in the RV between study groups, a RV > 1.8 showed better predictive performance for extubation failure compared to p01 and Yang and Tobin. Finally, mortality was higher in patients with ventilatory failure and RV > 1.8 (30.7%) compared to RV < 1.8 (19.6%). Conclusion: RV was different in patients undergoing cardiothoracic surgery with and without extubation failure.


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