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Neurocritical Care
Published in: Neurocritical Care 2/2016

01-04-2016 | Original Article

Association of Extubation Failure and Functional Outcomes in Patients with Acute Neurologic Illness

Authors: Muhammad Adeel Rishi, Rahul Kashyap, Gregory Wilson, Louis Schenck, Sara Hocker

Published in: Neurocritical Care | Issue 2/2016

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Abstract

Background

An association between extubation failure and neurologic and functional outcomes in patients with primary neurologic illness has not been investigated rigorously. We plan to conduct a retrospective chart review to study this association.

Methods

A total of 949 unique patients intubated and ventilated for at least 48 h in Neuro ICU (NICU) were obtained. Extubation failure was defined as need for reintubation within 48 h of initial extubation. Independent and dependent association between extubation failure and clinical parameters was assessed.

Results

The patients had a median age [interquartile range (IQR)] of 58.5 (23.0) years. 60.5 % were male and 81.9 % were Caucasian. Extubation failure occurred in 108 (12.8 %) patients. There was no difference in age, APACHE 3 score, FOUR score, or GCS score of patients at ICU admission between those who experienced extubation failure and those who did not. Extubation failure was associated with longer NICU and hospital LOS [median (IQR); 13.7 (11.3) vs. 9.1(8.2) days, P < 0.01 and 24.5 (20.0) vs. 16.8 (16.7) days, P < 0.01]. Patients with extubation failure had worse functional outcomes at 6 months as measured by the modified Rankin score [MRS; median (IQR), 5.0 (2.0) vs. 4.0 (3.0), P < 0.01]. After adjusting for confounders, extubation failure was associated with longer hospital and ICU LOS and worse functional outcomes.

Conclusions

In patients with acute neurological illness, extubation failure is associated with longer ICU and hospital stays but does not impact hospital mortality. Patients with extubation failure may experience a worsening of their functional status over time.
Literature
1.
Esteban A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P, Arroliga AC, Tobin MJ. Mechanical ventilation international study group. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002;287:345–55.CrossRefPubMed
2.
Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161:1530–6.CrossRefPubMed
3.
dos Reis HFC, Almeida MLO, da Silva MF, de Seixas Rocha M. Extubation failure influences clinical and functional outcomes in patients with traumatic brain injury. J Bras Pneumol. 2013;39:330–8.CrossRefPubMedPubMedCentral
4.
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. Am J Respir Crit Care Med. 1998;158:1855–62.CrossRefPubMed
5.
Ko R, Ramos L, Chalela JA. Conventional weaning parameters do not predict extubation failure in neurocritical care patients. Neurocrit Care. 2009;10:269–73.CrossRefPubMed
6.
Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997;112:186–92.CrossRefPubMed
7.
Seymour CW, Martinez A, Christie JD, Fuchs BD. The outcome of extubation failure in a community hospital intensive care unit: a cohort study. Crit Care. 2004;8:322–7.CrossRef
8.
Vidotto MC, Sogame LC, Gazzotti MR, Prandini M, Jardim JR. Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery. Braz J Med Biol Res. 2011;44:1291–8.CrossRefPubMed
9.
Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991;324:1445–50.CrossRefPubMed
10.
Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med. 2011;39:2612–8.CrossRefPubMed
11.
Rishi MA, Kashyap R, Wilson G, Hocker S. Retrospective derivation and validation of a search algorithm to identify extubation failure in the intensive care unit. BMC Anesthesiol. 2014;14:41.CrossRefPubMedPubMedCentral
12.
Chute CG, Beck SA, Fisk TB, Mohr DN. The enterprise data trust at Mayo clinic: a semantically integrated warehouse of biomedical data. J Am Med Inform Assoc. 2010;17:131–5.CrossRefPubMedPubMedCentral
13.
Alsara A, Warner DO, Li G, Herasevich V, Gajic O, Kor DJ. Derivation and validation of automated electronic search strategies to identify pertinent risk factors for postoperative acute lung injury. Mayo Clin Proc. 2011;86:382–8.CrossRefPubMedPubMedCentral
14.
Hsiao CJ, Hing E, Socey TC, Cai B. Electronic health record systems and intent to apply for meaningful use incentives among office-based physician practices: United States, 2001–2011. NCHS Data Brief. 2011;79:1–8.PubMed
15.
Adan M, Dettinger R. IBM data discovery and query builder: plug-ins by example. 1st ed. Rochester: IBM Corporation, International Technical Support Organization; 2003.
16.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2:81–4.CrossRefPubMed
17.
Wijdicks EF. Clinical scales for comatose patients: the Glasgow Coma Scale in historical context and the new FOUR Score. Rev Neurol Dis. 2006;3:109–17.PubMed
18.
Abrahão LA, De Marco FVC, Maciel FMB, Giudicissi M, Bianco ACM, Mora MA. Application of SOFA score to neurological patients admitted to intensive care unit. Crit Care. 2002;6:P237.CrossRefPubMedCentral
19.
Bonita R, Beaglehole R. Modification of Rankin Scale: recovery of motor function after stroke. Stroke. 1988;19:1497–500.CrossRefPubMed
20.
van Swieten J, Koudstaal P, Visser M, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–7.CrossRefPubMed
21.
Knaus WA, Wagner DP, Draper EA, et al. The APACHEIII prognostic system: risk prediction of hospital mortality for critical ill hospitalized patients. Chest. 1991;10:1619–36.CrossRef
22.
Suarez JI. Outcome in neurocritical care: advances in monitoring and treatment and effect of a specialized neurocritical care team. Crit Care Med. 2006;34:S232–8.CrossRefPubMed
23.
Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info: a general-purpose microcomputer program for public health information systems. Am J Prev Med. 1991;7:178–82.PubMed
24.
Anderson CD, Bartscher JF, Scripko PD, et al. Neurologic examination and extubation outcome in the neurocritical care unit. Neurocrit Care. 2011;15:490–7.CrossRefPubMed
25.
Rothaar RC, Epstein SK. Extubation failure: magnitude of the problem, impact on outcomes, and prevention. Curr Opin Crit Care. 2003;9:59–66.CrossRefPubMed
26.
Karanjia N, Nordquist D, Stevens R, Nyquist P. A clinical description of extubation failure in patients with primary brain injury. Neurocrit Care. 2011;15:4–12.CrossRefPubMed
27.
28.
MacIntyre NR, Cook DJ, Ely EW, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001;120:375S–95S.CrossRefPubMed
29.
Savi A, Teixeira C, Silva JM, et al. Weaning predictors do not predict extubation failure in simple-to-wean patients. J Crit Care. 2012;27:221.e1–8.CrossRefPubMed
30.
Teixeira C, Maccari JG, Vieira SR, et al. Impact of a mechanical ventilation weaning protocol on the extubation failure rate in difficult to wean patients. J Bras Pneumol. 2012;38:364–71.CrossRefPubMed
31.
Menon N, Joffe AM, Deem S, et al. Occurrence and complications of tracheal reintubation in critically ill adults. Respir Care. 2012;57:1555–63.CrossRefPubMed
32.
Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med. 1998;158:489–93.CrossRefPubMed
33.
Gowardman JR, Huntington D, Whiting J. The effect of extubation failure on outcome in a multidisciplinary Australian intensive care unit. Crit Care Resusc. 2006;8:328–33.PubMed
34.
Garnacho-Montero J, Amaya-Villar R, García-Garmendía JL, Madrazo-Osuna J, Ortiz-Leyba C. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med. 2005;33:349–54.CrossRefPubMed
35.
Navalesi P, Frigerio P, Moretti MP, et al. Rate of reintubation in mechanically ventilated neurosurgical and neurologic patients: evaluation of a systematic approach to weaning and extubation. Crit Care Med. 2008;36:2986–92.CrossRefPubMed
Metadata
Title
Association of Extubation Failure and Functional Outcomes in Patients with Acute Neurologic Illness
Authors
Muhammad Adeel Rishi
Rahul Kashyap
Gregory Wilson
Louis Schenck
Sara Hocker
Publication date
01-04-2016
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2016
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-015-0156-3

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