Sosa-Medellín MA, Marín-Romero MC

Language: Spanish
References: 9
Page: 459-465
PDF size: 201.87 Kb.

ABSTRACT

Background: Invasive ventilatory support is a therapeutic measure commonly used in the Intensive Care Units, cured the disease that caused the ventilatory support begins with withdrawal of this modality. Once the withdrawal is performed, a failed extubation can occur in up to 20% of patients, requiring reintubation.
Objetive: To report the frequency of failed extubation in the Adult Intensive Care Unit from the Hospital 1^° de Octubre, ISSSTE, Mexico.
Material and Method: An analytical, observational and transversal study was made in the intensive care unit; files were analyzed in the period from March 1^st , 2014 to February 28, 2015, with support of mechanical ventilation for more than 24 hours and extubated after a successful spontaneous breath trail.
Results: One hundred forty-six records were identified, 74 (51%) were female, with a mean age of 56 years. The indications for mechanical ventilation were: shock state 44 (30%), postoperative 40 (27%). The percentage of ventilation withdrawal failure was 18%. The risk of prevalence for failed extubation: for midazolam OR 4.8 (95% CI 1.56-14.8, p=0.002), obesity OR 2.5 (95% CI 1.07-6.16), neurological deterioration as an indication of ventilation OR 6 (95% CI 3.14-11.8), metabolic acidosis OR 5.2 (95% CI 1.2-22.6).
Conclusion: The prevalence of failed extubation in our intensive care unit is 18%, similar to that reported in the literature.

REFERENCES

1. Machado F, Maciel A, de Mello M, Meneguzzi C, et al. Reflex cough PEF as a predictor of successful extubation in neurological patients. J Bras Pneumol 2015;41(4):358-364.

2. Alvarado G, Barragan JR, Aguilera M, Garza AG, Maltos W. Incidencia de extubaciones fallidas y factores de riesgo concomitantes en pacientes de la unidad de terapia intensiva pediátrica: Experiencia en un Hospital Universitario. Medicina Universitaria 2007;9:7-12.

3. Artime C, Hagberg C. Tracheal extubation. Respir Care 2014;59(6):991-1005.

4. Kress JP, Pohlman A, Oconnor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000;342(20):1471-1477.

5. Apezteguia C, Violi D. Suspensión de la ventilación mecánica. En: Chiappero G, Villarejo F. Ventilación Mecánica, Libro del Comité de Neumonología Crítica de la SATI. Argentina: Panamericana, 2010;343-372.

6. Thille A, Cortes I, Esteban A. Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care 2013;19:57-64.

7. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;112:186-192.

8. Thille AW, Harrois A, Schortgen F, et al. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med 2011;39:2612-2618.

9. Klompas M, Li L, Szumita P, Kleinman K, Murphy M. Associations between different sedatives and ventilator-associated events, length of stay, and mortality in patients who were mechanically ventilated. Chest 2016;149(6):1373-9.