Prediction of extubation failure in medical intensive care unit patients
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Prediction of extubation failure in medical intensive care unit patients. / Saugel, Bernd; Rakette, Philipp; Hapfelmeier, Alexander; Schultheiss, Caroline; Phillip, Veit; Thies, Philipp; Treiber, Matthias; Einwächter, Henrik; von Werder, Alexander; Pfab, Rudi; Eyer, Florian; Schmid, Roland M; Huber, Wolfgang.
in: J CRIT CARE, Jahrgang 27, Nr. 6, 01.12.2012, S. 571-7.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Prediction of extubation failure in medical intensive care unit patients
AU - Saugel, Bernd
AU - Rakette, Philipp
AU - Hapfelmeier, Alexander
AU - Schultheiss, Caroline
AU - Phillip, Veit
AU - Thies, Philipp
AU - Treiber, Matthias
AU - Einwächter, Henrik
AU - von Werder, Alexander
AU - Pfab, Rudi
AU - Eyer, Florian
AU - Schmid, Roland M
AU - Huber, Wolfgang
N1 - Copyright © 2012 Elsevier Inc. All rights reserved.
PY - 2012/12/1
Y1 - 2012/12/1
N2 - PURPOSE: The purpose of this study was to evaluate prediction factors for extubation failure (need for reintubation within 48 hours) in medical intensive care unit patients.MATERIALS AND METHODS: Sixty-one patients extubated after mechanical ventilation for more than 48 hours were included in the study. A retrospective analysis of medical records and a prospectively maintained database on respiratory parameters was conducted.RESULTS: Low serum anion gap (P = .001), low serum anion gap corrected for serum albumin (P = .010), and low arterial partial pressure of oxygen (Pao(2))/fraction of inspired oxygen (Fio(2)) ratio (P = .032) were significantly associated with extubation failure. Binary logistic regression analysis revealed low uncorrected and corrected serum anion gap (P = .006 and P = .025, respectively; odds ratio, 0.59 for both) and low Pao(2)/Fio(2) ratio (P = .038; odds ratio, 0.99) as risk factors for extubation failure. Regarding extubation failure, receiver operating characteristic curve (ROC) analysis demonstrated good predictive capabilities of serum anion gap (ROC area under the curve, 0.835; P = .004; cutoff, 7.7 mEq/L; sensitivity, 70.4%; specificity, 85.7%) and corrected serum anion gap (ROC area under the curve, 0.808; P = .009; cutoff, 8.8 mEq/L; sensitivity, 87.5%; specificity, 71.4%). A significantly higher risk for extubation failure was observed in patients with serum anion gap 5.2 mEq/L or less (relative risk, 8.8; 95% confidence interval, 2.4-32.4; P = .004) and corrected serum anion gap 8.6 mEq/L or less (relative risk, 10.0; 95% confidence interval, 2.2-44.9; P = .004).CONCLUSIONS: Low preextubation serum anion gap values and low preextubation Pao(2)/Fio(2) ratio might help to predict extubation failure in medical intensive care unit patients.
AB - PURPOSE: The purpose of this study was to evaluate prediction factors for extubation failure (need for reintubation within 48 hours) in medical intensive care unit patients.MATERIALS AND METHODS: Sixty-one patients extubated after mechanical ventilation for more than 48 hours were included in the study. A retrospective analysis of medical records and a prospectively maintained database on respiratory parameters was conducted.RESULTS: Low serum anion gap (P = .001), low serum anion gap corrected for serum albumin (P = .010), and low arterial partial pressure of oxygen (Pao(2))/fraction of inspired oxygen (Fio(2)) ratio (P = .032) were significantly associated with extubation failure. Binary logistic regression analysis revealed low uncorrected and corrected serum anion gap (P = .006 and P = .025, respectively; odds ratio, 0.59 for both) and low Pao(2)/Fio(2) ratio (P = .038; odds ratio, 0.99) as risk factors for extubation failure. Regarding extubation failure, receiver operating characteristic curve (ROC) analysis demonstrated good predictive capabilities of serum anion gap (ROC area under the curve, 0.835; P = .004; cutoff, 7.7 mEq/L; sensitivity, 70.4%; specificity, 85.7%) and corrected serum anion gap (ROC area under the curve, 0.808; P = .009; cutoff, 8.8 mEq/L; sensitivity, 87.5%; specificity, 71.4%). A significantly higher risk for extubation failure was observed in patients with serum anion gap 5.2 mEq/L or less (relative risk, 8.8; 95% confidence interval, 2.4-32.4; P = .004) and corrected serum anion gap 8.6 mEq/L or less (relative risk, 10.0; 95% confidence interval, 2.2-44.9; P = .004).CONCLUSIONS: Low preextubation serum anion gap values and low preextubation Pao(2)/Fio(2) ratio might help to predict extubation failure in medical intensive care unit patients.
KW - Acid-Base Equilibrium
KW - Aged
KW - Airway Extubation
KW - Blood Gas Analysis
KW - Female
KW - Humans
KW - Intensive Care Units
KW - Male
KW - Middle Aged
KW - ROC Curve
KW - Retrospective Studies
KW - Serum Albumin
KW - Ventilator Weaning
U2 - 10.1016/j.jcrc.2012.01.010
DO - 10.1016/j.jcrc.2012.01.010
M3 - SCORING: Journal article
C2 - 22440323
VL - 27
SP - 571
EP - 577
JO - J CRIT CARE
JF - J CRIT CARE
SN - 0883-9441
IS - 6
ER -