Association between fluid intake and extubation failure in intensive care unit patients with negative fluid balance: a retrospective observational study

Abstract

Background Negative fluid balance (NFB) is associated with reduced extubation failure. However, whether achieving more NFB can further improve extubation outcome has not been investigated. This study aimed to investigate whether more NFB and restricted fluid intake were associated with extubation success. Methods We performed a retrospective study of adult patients with mechanical ventilation (MV) admitted to Medical Information Mart for Intensive Care (MIMIC-III) from 2001 to 2012. Patients with duration of MV over 24 hours and NFB within 24 hours before extubation were included for analysis. The primary outcome was extubation failure, defined as reintubation within 72 hours after extubation. Association between fluid balance or fluid intake and extubation outcome were investigated with multivariable logistic models. Results A total of 3433 extubation events were recorded. 1803 with NFB were included for the final analysis, of which 201(11.1%) were extubation failure. Compared with slight NFB (− 20 to 0 ml/kg), more NFB were not associated improved extubation outcome. Compared with moderate fluid intake (30 to 60 ml/kg), lower (< 30 ml/kg, OR 0.75, 95% CI [0.54, 1.05], p = 0.088) or higher (> 60 ml/kg, OR 1.63, 95% CI [0.73, 3.35], p = 0.206) fluid intake was not associated with extubation outcome. Duration of MV, chronic obstructive pulmonary disease (COPD), hypercapnia, use of diuretics, and SAPSIIscore were associated with extubation failure. Conclusions More NFB or restricted fluid intake were not associated with reduced extubation failure in patients with NFB. However, for COPD patients, restricted fluid intake was associated with extubation success.

Risk Factors for Weaning Failure in COVID-19 Patients

“…Other clinical variables such as fluid balance and heart failure, which have been associated with clinical outcomes in previous studies [35], [36], were associated with weaning in the initial univariate analysis but we found no significant association between those variables and the weaning outcome in the multivariate analysis. We believe that both fluid balance and heart failure can have an adverse impact on weaning from MV.…”

Incidence of extubation failure and its predictors among adult patients in intensive care unit of low-resource setting: A prospective observational study

“…Our study also found that the prolonged duration of intubation > 10 days was significantly associated with extubation failure compared with a shorter MV duration. In the same way, many studies reported that longer MV stays significantly increased the risk of developing EF [ 2 , 13 , and 34 ]. Evidence depicted that considering early tracheostomy for those patients anticipated to have prolonged intubation may avert the occurrences of EF [ 35 , 36 ].…”

“…Previous studies have found an association between a variety of predictors and extubation failure: the severity of critical illness, old-age patients, co-existing disease, positive fluid balance, and amount of airway secretions, poor cough reflexes, impaired mental status, and unstable hemodynamic parameters [ 1 , 2 , 12 – 17 ]. Nonetheless, conflicting results are reported depending on the studied population, weaning parameters, trained expertise, and medical resource available in the clinical setup [ 18 – 20 ].…”