Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures

Jaber, Samir; Quintard, Hervé; Cinotti, Raphaël; Asehnoune, Karim; Arnal, Jean-Michel; Guitton, Christophe; Paugam–Burtz, Catherine; Abback, Paer; Dessap, Armand Mekontso; Lakhal, Karim; Lasocki, Sigismond; Plantefève, Gaëtan; Claud, Bernard; Pottecher, Julien; Corne, Philippe; Ichaï, Carole; Hajjej, Zied; Molinari, Nicolas; Chanques, Gérald; Papazian, Laurent; Azoulay, Élie; Jong, Audrey De

doi:10.1186/s13054-018-2150-6

Cited by 113 publications

(108 citation statements)

References 51 publications

(73 reference statements)

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“…Daily screening of respiratory function by SBT is associated with a shorter duration of mechanical ventilation [27]. After a successful SBT and extubation, 10 to 25% of patients require reintubation, and reintubation is associated with higher mortality [28,29]. In this meta-analysis, the reintubation rate was not significantly different between the 2 groups (about 14.1%), which is lower than the 17% in the first study by Esteban et al [16] and similar to the 13% in their second study [30].…”

Section: Discussionmentioning

confidence: 99%

Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

Zhang

2020

Crit Care

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Background: The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. A systematic review and meta-analysis was performed to clarify the preferable SBT (T-piece or pressure support ventilation [PSV]). Methods:We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) from inception to the 31st of July 2019. We included RCTs involving adult patients (> 18 years) who underwent at least two different SBT methods. All authors reported our primary outcome of successful extubation rate and clearly compared PS versus T-piece with clinically relevant secondary outcomes (rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results: Ten RCTs including 3165 patients were included. The results of this meta-analysis showed that there was no significant difference in the successful extubation rate between the T-piece group and PS group (odds ratio [OR] = 0.91; 95% CI, 0.78-1.07; P = 0.27; I 2 = 79%). In addition, compared with the PS group, the T-piece group showed no significant difference in the rate of reintubation (odds ratio [OR] = 0.99; 95% CI, 0.78-1.26; P = 0.95; I 2 = 5%), ICU mortality (odds ratio [OR] = 1.22; 95% CI, 0.83-1.80; P = 0.30; I 2 = 0%), hospital mortality (odds ratio [OR] = 1.36; 95% CI, 0.99-1.87; P = 0.06; I 2 = 19%), ICU length of stay (mean difference = − 0.10; 95% CI, − 0.59 to 0.39; P = 0.69; I 2 = 13%), and hospital length of stay (mean difference = − 0.82;95% CI, − 2.2 to 0.55; P = 0.24; I 2 = 0%). Conclusions: T-piece and PSV as SBTs are considered to have comparable predictive power of successful extubation in critically ill patients. The analysis of secondary outcomes also shows no significant difference in the rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality between the two groups. Further randomized controlled studies of SBTs are still required.

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Section: Discussionmentioning

confidence: 99%

Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

Zhang

2020

Crit Care

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“…For men, more than two intubation attempts were related to stridor and hoarseness (p ¼ 0.006). The median [interquartile range] number of intubation days was significantly higher in those with than without symptoms (5 [3][4][5][6][7][8][9] vs. 3 [2][3][4][5][6] days, respectively; p ¼ 0.014), and the median [interquartile range] length of hospital stay was significantly longer in those with than without symptoms (26.5 [12.25-36.75] vs. 12 [8.25-21.25] days, respectively; p ¼ 0.006) ( Table 3).…”

Section: Resultsmentioning

confidence: 99%

Risk factors associated with symptoms of post-extubation upper airway obstruction in the emergency setting

et al. 2020

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Objective Post-extubation stridor and hoarseness are important clinical manifestations that indicate laryngeal edema due to intubation. In previous studies the incidence of post-extubation stridor and hoarseness ranged from 1.5% to 26.3% in postoperative patients and patients in the intensive care unit. Female sex and prolonged intubation are reportedly risk factors for post-extubation stridor. However, the risk factors for post-extubation stridor and the appropriate endotracheal tube size in emergency settings remain unknown. This study was performed to identify the risk factors for post-extubation laryngeal edema after emergency intubation. Methods A prospective observational study was conducted in a tertiary emergency medical center/trauma center. The primary outcome was post-extubation stridor and hoarseness. Results During the study period, 482 emergency intubations and 227 extubations were performed in adult patients. In total, 29% of the patients presented symptoms of stridor and/or hoarseness. Female sex (odds ratio, 2.65; 95% confidence interval, 1.21–5.81) and the duration of intubation (odds ratio, 1.18; 95% confidence interval, 1.05–1.32) were associated with stridor and/or hoarseness. Conclusions Patients who undergo emergency intubation have a higher risk of post-extubation upper airway obstruction symptoms than postoperative patients and patients in the intensive care unit, and female sex is associated with these symptoms.

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“…13 In addition, being on mechanical ventilation for more than 7 or 8 days before extubation is a risk factor for EF. 13,14 However, strategies for reducing EF in patients on mechanical ventilation for more than 7 days are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, being on mechanical ventilation for more than 7 days before extubation is associated with a 2.87‐fold increase in EF 72 h following extubation and a 3.66‐fold increase 7 days following extubation 13 . In addition, being on mechanical ventilation for more than 7 or 8 days before extubation is a risk factor for EF 13,14 . However, strategies for reducing EF in patients on mechanical ventilation for more than 7 days are lacking.…”

Section: Introductionmentioning

confidence: 99%

Preventive use of non‐invasive ventilation is associated with reduced risk of extubation failure in patients on mechanical ventilation for more than 7 days: a propensity‐matched cohort study

Jiang

Pan

2020

Internal Medicine Journal

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Background: Extubation failure (EF) is high in patients on mechanical ventilation for more than 7 days. However, strategies to prevent EF in this population are lacking. Aims: To evaluate the efficacy of preventive use of noninvasive ventilation in patients on mechanical ventilation for more than 7 days. Methods: We performed a retrospective study in an intensive care unit of a teaching hospital. We enrolled patients who received mechanical ventilation for more than 7 days and successfully completed a weaning trial. After extubation, patients who immediately received non-invasive ventilation (NIV) were classified as the NIV group, and those who received conventional oxygenation therapy only were classified as the usual care group. Results: We enrolled 95 patients in the NIV group and 61 patients in the usual care group. NIV is associated with reduced risk of EF compared to usual care both 72 h following extubation (11.6% vs 32.8%, P < 0.01, for the overall cohort; 8.6% vs 42.9%, P < 0.01, for the propensity-matched cohort) and 7 days following extubation (25.3% vs 45.9%, P < 0.01, for the overall cohort; 28.6% vs 51.4%, P = 0.09, for the propensity-matched cohort). Within 7 days of extubation, the NIV group had a lower proportion of EF than the controls (log rank test: P < 0.01 and P = 0.02 for the overall and propensity-matched cohorts, respectively). Conclusions: In patients on mechanical ventilation for more than 7 days, preventive use of NIV is associated with a reduction in EF.

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Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures

Cited by 113 publications

References 51 publications

Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

Risk factors associated with symptoms of post-extubation upper airway obstruction in the emergency setting

Preventive use of non‐invasive ventilation is associated with reduced risk of extubation failure in patients on mechanical ventilation for more than 7 days: a propensity‐matched cohort study

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