Please use this identifier to cite or link to this item: https://doi.org/10.1111/jocs.14189
Title: To extubate or not to extubate: Risk factors for extubation failure and deterioration with further mechanical ventilation
Authors: Xie, Jingui
Cheng, Guang 
Zheng, Zhichao
Luo, Haidong
Ooi, Oon Cheong 
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Surgery
Cardiovascular System & Cardiology
decision to extubate
deterioration
extubation failure
mechanical ventilation
risk factors
ICU
EPIDEMIOLOGY
PREDICTION
OUTCOMES
SURGERY
Issue Date: 2-Aug-2019
Publisher: WILEY
Citation: Xie, Jingui, Cheng, Guang, Zheng, Zhichao, Luo, Haidong, Ooi, Oon Cheong (2019-08-02). To extubate or not to extubate: Risk factors for extubation failure and deterioration with further mechanical ventilation. JOURNAL OF CARDIAC SURGERY 34 (10) : 1004-1011. ScholarBank@NUS Repository. https://doi.org/10.1111/jocs.14189
Abstract: Background: Extubation is a critical step in the intensive care unit (ICU). In this study, we aim to investigate the risk factors for both extubation failure and deterioration with further mechanical ventilation (MV). Methods: Data were collected from a cardiothoracic ICU in a tertiary hospital. The risk factors for extubation failure and deterioration with further MV were investigated by multivariate logistic regression. Results: A total of 676 patients were enrolled in the study. Patients with extubation failure had a longer ICU length of stay and a higher mortality rate than patients without extubation failure. An age greater than 65 years, abnormal heart rate, respiratory rate exceeding 20 times/min, arterial pH lower than 7.35, pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FiO2) ratio lower than 300 mmHg, mean arterial pressure lower than 70 mmHg, duration of MV longer than 12 hours, and high quick Sequential Organ Failure Assessment (qSOFA) score were independent risk factors for extubation failure. Furthermore, we found that a respiratory rate greater than 20 times/min and a PaO2/fraction of Inspired Oxygen FiO2 ratio less than 300 mmHg were protective factors, while a mean arterial pressure lower than 70 mmHg, arterial pH lower than 7.35, and high qSOFA score were risk factors for deterioration on continued MV. Conclusions: Since the duration of MV increases the risk of extubation failure, physicians should consider not only the risk of extubation failure but also the risk of deterioration with further MV.
Source Title: JOURNAL OF CARDIAC SURGERY
URI: https://scholarbank.nus.edu.sg/handle/10635/235032
ISSN: 0886-0440
1540-8191
DOI: 10.1111/jocs.14189
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