Article Data

  • Views 2539
  • Dowloads 230

Original Research

Open Access

The effect of the physiological reserve surrogate characteristics on non-airway extubation failure in patients with pneumonia with high Burns Wean Assessment Program scores

  • Rakan M. AlQahtani1
  • Yasmeen Khalaf Altaymani2
  • Saud Ali Aljasir2
  • Bader Abdulaziz Zawawi1
  • Hisham Khaled Algossy1
  • Khalid Waleed Alhusainan1
  • Mohammed Yousef Alyousef1
  • Mohammed Ibrahim Alarifi1
  • Abdalrhman Al saadon1

1Department of Critical Care Medicine, College of Medicine, King Saud University, 11451 Riyadh, Saudi Arabia

2Department of Critical Care Medicine and Respiratory Care Services, King Khaled University Hospital, 12372 6864 Riyadh, Saudi Arabia

DOI: 10.22514/sv.2021.094 Vol.17,Issue 6,November 2021 pp.90-102

Submitted: 23 March 2021 Accepted: 25 April 2021

Published: 08 November 2021

*Corresponding Author(s): Rakan M. AlQahtani E-mail: arakan@ksu.edu.sa

Abstract

Objectives: A successful weaning prediction score could be a useful tool to predict non-airway extubation failure. However, it may carry some challenges without considering the effect of the physiological reserve on the sustainability of extubation. This study investigated the possible correlation between the physiological reserve surrogate characteristics including acute, baseline, and biochemical patients’ factors and non-airway extubation failure in patients with pneumonia.

Methods: A retrospective cohort study at two academic teaching hospitals was conducted between January 2019 and January 2020 with patients with pneumonia requiring invasive mechanical ventilation and with Burns Wean Assessment Program (BWAP) scores equal to or exceeding 50. Acute clinical, biochemical, and baseline characteristics were collected for both successful and failed non-airway extubation patients.

Results: Among 313 patients, the mean age was 63.63 ± 10.44 years and most of the patients were males (60.7%). The median invasive mechanical duration was 7 days [Interquartile range (IQR): 5–12], the median length of ICU stay was 12 [IQR: 6–23] and the in-hospital mortality was 16.9%. Among this cohort of patients with pneumonia, 37.7% had non-airway extubation failure. Multivariate logistic regression analyses showed that higher CURB-65 score, longer duration of invasive mechanical ventilation, hemodynamic instability, healthcare-associated pneumonia, older men, history of diabetes mellitus, history of cardiac disease, hypophosphatemia, hypocalcemia, and higher admission serum sodium were associated with increased risk of non-airway extubation failure in patients with pneumonia with high BWAP score.

Conclusion: A distinct successful weaning score for patients with pneumonia that considers patients’ acute clinical, biochemical, and baseline characteristics may be effective, and these factors could be reflective of the underlying physiological reserve. Sustainability score from IMV rather than weaning score is needed and may be more predictive for the extubation outcome.


Keywords

Extubation failure; Intensive care unit; Mechanical ventilation; Pneumonia; Physiological reserve; CURB-65


Cite and Share

Rakan M. AlQahtani,Yasmeen Khalaf Altaymani,Saud Ali Aljasir,Bader Abdulaziz Zawawi,Hisham Khaled Algossy,Khalid Waleed Alhusainan,Mohammed Yousef Alyousef,Mohammed Ibrahim Alarifi,Abdalrhman Al saadon. The effect of the physiological reserve surrogate characteristics on non-airway extubation failure in patients with pneumonia with high Burns Wean Assessment Program scores. Signa Vitae. 2021. 17(6);90-102.

References

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

[2] Miller RL, Cole RP. Association between reduced cuff leak volume and postextubation stridor. Chest. 1996; 110: 1035–1040.

[3] Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdu V, et al. A comparison of four methods of weaning patients from mechanical ventilation. New England Journal of Medicine. 1995; 332: 345–350.

[4] Luo J, Yu H, Ni Y, Hu Y, Liu D, Wang M, et al. Early prediction of extubation failure in severe pneumonia: a retrospective cohort study. Acute Critical Care. 2020; 40: BSR20192435.

[5] Seymour CW, Martinez A, Christie JD, Fuchs BD. The outcome of extubation failure in a community hospital intensive care unit: a cohort study. Critical Care. 2004; 8: R322–R327.

[6] Agarwal V. Extubation failure in intensive care unit: predictors and management. Indian Journal of Critical Care Medicine. 2008; 12: 1–9.

[7] Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. American Journal of Respiratory and Critical Care Medicine. 1998; 158: 489–493.

[8] Frutos-Vivar F, Ferguson ND, Esteban A, Epstein SK, Arabi Y, Apezteguía C, et al. Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest. 2006; 130: 1664–1671.

[9] Jaber S, Quintard H, Cinotti R, Asehnoune K, Arnal J, Guitton C, et al. Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures. Critical Care. 2018; 22: 236.

[10] Tu C, Chang C, Chang S, Lee C, Chang C. A decision for predicting successful extubation of patients in intensive care unit. BioMed Research International. 2018; 2018: 6820975.

[11] Thille AW, Richard JM, Brochard L. The decision to extubate in the intensive care unit. American Journal of Respiratory and Critical Care Medicine. 2013; 187: 1294–1302.

[12] Carpio ALM, Mora JI. Ventilator management. StatPearls Pub-lishing. 2019. Available from: https://www.statpearls.com/ArticleLibrary/viewarticle/31075

[13] Zein H, Baratloo A, Negida A, Safari S. Ventilator weaning and spontaneous breathing trials; an educational review. Emergency. 2016; 4: 65–71.

[14] Subirà C, Hernández G, Vázquez A, Rodríguez-García R, González-Castro A, García C, et al. Effect of pressure support vs T-piece ventilation strategies during spontaneous breathing trials on successful extubation among patients receiving mechanical ventilation: a randomized clinical trial. Journal of the American Medical Association. 2019; 321: 2175–82.

[15] Fernando SM, McIsaac DI, Rochwerg B, Bagshaw SM, Muscedere J, Munshi L, et al. Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy. Intensive Care Medicine. 2019; 45: 1742–1752.

[16] Ince C. Personalized physiological medicine. Critical Care. 2017; 21: 308.

[17] Bayliss EA, Ellis JL, Steiner JF. Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument. Health and Quality of Life Outcomes. 2005; 3: 51.

[18] Sellares J, Ferrer M, Cano E, Loureiro H, Valencia M, Torres A. Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU. Intensive Care Medicine. 2011; 37: 775–784.

[19] Peña-López Y, Ramirez-Estrada S, Eshwara VK, Rello J. Limiting ventilator-associated complications in ICU intubated subjects: strategies to prevent ventilator-associated events and improve outcomes. Expert Review of Respiratory Medicine. 2018; 12: 1037–1050.

[20] Alía I, Esteban A. Weaning from mechanical ventilation. Critical Care. 2000; 4: 72–80.

[21] Burns SM, Fisher C, Earven Tribble SS, Lewis R, Merrel P, Conaway MR, et al. Multifactor clinical score and outcome of mechanical ventilation weaning trials: burns wean assessment program. American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses. 2010; 19: 431–439.

[22] Boles J, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. The European Respiratory Journal. 2007; 29: 1033–1056.

[23] Chhetri JK, Xue QL, Ma L, Chan P, Varadhan R. Intrinsic capacity as a determinant of physical resilience in older adults. Journal of Nutrition Health & Aging. 2021; 1–6.

[24] Burns SM, Fisher C, Tribble SES, Lewis R, Merrel P, Conaway MR, et al. The relationship of 26 clinical factors to weaning outcome. American Journal of Critical Care. 2012; 21: 52–59.

[25] Jeong ES, Lee K. Clinical application of modified burns wean assessment program scores at first spontaneous breathing trial in weaning patients from mechanical ventilation. Acute and Critical Care. 2018; 33: 260–268.

[26] Burns SM, Marshall M, Burns JE, Ryan B, Wilmoth D, Carpenter R, et al. Design, testing, and results of an outcomes-managed approach to patients requiring prolonged mechanical ventilation. American Journal of Critical Care. 1998; 7: 45–49.

[27] Vignon P. Cardiovascular failure and weaning. Annals of Translational Medicine. 2018; 6: 354.

[28] Yu H, Luo J, Ni Y, Hu Y, Liu D, Wang M, et al. Early prediction of extubation failure in patients with severe pneumonia: a retrospective cohort study. Bioscience Reports. 2020; 40: BSR20192435

[29] Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical intensive care unit patients. Critical Care Medicine. 2011; 39: 2612–2618.

[30] Vallverdú I, Calaf N, Subirana M, Net A, Benito S, Mancebo J. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. American Journal of Respiratory and Critical Care Medicine. 1999; 158: 1855–1862.

[31] Lee KH, Hui KP, Chan TB, Tan WC, Lim TK. Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome. Chest. 1994; 105: 540–543.

[32] Capdevila XJ, Perrigault PF, Perey PJ, Roustan JP, d’Athis F. Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial. Chest. 1995; 108: 482–489.

[33] Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Critical Care Medicine. 1999; 27: 340–347.

[34] Suraseranivong R, Krairit O, Theerawit P, Sutherasan Y. Association between age-related factors and extubation failure in elderly patients. PLoS ONE. 2018; 13: e0207628.

[35] Alsumrain MH, Jawad SA, Imran NB, Riar S, DeBari VA, Adelman M. Association of hypophosphatemia with failure-to-wean from mechanical ventilation. Annals of Clinical and Laboratory Science. 2010; 40: 144–148.

[36] Aubier M, Murciano D, Lecocguic Y, Viires N, Jacquens Y, Squara P, et al. Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure. New England Journal of Medicine. 1985; 313: 420–424.

[37] Dooley J, Fegley A. Laboratory monitoring of mechanical ventilation. Critical Care Clinics. 2007; 23: 135–48.

[38] Kohno S, Seki M, Takehara K, Yamada Y, Kubo K, Ishizaka A, et al. Prediction of requirement for mechanical ventilation in community-acquired pneumonia with acute respiratory failure: a multicenter prospective study. Respiration. 2013; 85: 27–35.

[39] Ilg A, Moskowitz A, Konanki V, Patel PV, Chase M, Grossestreuer AV, et al. Performance of the CURB-65 score in predicting critical care interventions in patients admitted with community-acquired pneumonia. Annals of Emergency Medicine. 2019; 74: 60–68.



Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top