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JA Clinical Reports

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Open Access 01-12-2022 | Expectoration | Clinical Research Article

Frequent tracheal suctioning is associated with extubation failure in patients with successful spontaneous breathing trial: a single-center retrospective cohort study

Authors: Junpei Haruna, Hiroomi Tatsumi, Satoshi Kazuma, Aki Sasaki, Yoshiki Masuda

Published in: JA Clinical Reports | Issue 1/2022

Abstract

Background

Extubation failure, i.e., reintubation in ventilated patients, is a well-known risk factor for mortality and prolonged stay in the intensive care unit (ICU). Although sputum volume is a risk factor, the frequency of tracheal suctioning has not been validated as a predictor of reintubation. We conducted this study to examine whether frequent tracheal suctioning is a risk factor for reintubation.

Patients and methods

We included adult patients who were intubated for > 72 h in the ICU and extubated after completion of spontaneous breathing trial (SBT). We compared the characteristics and weaning-related variables, including the frequency of tracheal suctioning between patients who required reintubation within 24 h after extubation and those who did not, and examined the factors responsible for reintubation.

Results

Of the 400 patients enrolled, reintubation was required in 51 (12.8%). The most common cause of reintubation was difficulty in sputum excretion (66.7%). There were significant differences in sex, proportion of patients with chronic kidney disease, pneumonia, ICU admission type, the length of mechanical ventilation, and ICU stay between patients requiring reintubation and those who did not. Multivariate analysis showed frequent tracheal suction (> once every 2 h) and the length of mechanical ventilation were independent factors for predicting reintubation.

Conclusion

We should examine the frequency of tracheal suctioning > once every 2 h in addition to the length of mechanical ventilation before deciding to extubate after completion of SBT in patients intubated for > 72 h in the ICU.

Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997;112:186–92. https://doi.org/10.1378/chest.112.1.186.CrossRefPubMed

Jaber S, Quintard H, Cinotti R, Asehnoune K, Arnal JM, 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. Crit Care. 2018;22:236. https://doi.org/10.1186/s13054-018-2150-6.CrossRefPubMedPubMedCentral

Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013;187:1294–302. https://doi.org/10.1164/rccm.201208-1523CI.CrossRefPubMed

Girard TD, Alhazzani W, Kress JP, Ouellette DR, Schmidt GA, Truwit JD, et al. An official American Thoracic Society/American College of Chest Physicians clinical practice guideline: liberation from mechanical ventilation in critically ill adults. Rehabilitation protocols, ventilator liberation protocols, and cuff leak tests. Am J Respir Crit Care Med. 2017;195:120–33. https://doi.org/10.1164/rccm.201610-2075ST.CrossRefPubMed

Epstein SK. Decision to extubate. Intensive Care Med. 2002;28:535–46. https://doi.org/10.1007/s00134-002-1268-8.CrossRefPubMed

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. https://doi.org/10.1056/NEJM199105233242101.CrossRefPubMed

Thille AW, Cortés-Puch I, Esteban A. Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care. 2013;19:57–64. https://doi.org/10.1097/MCC.0b013e32835c5095.CrossRefPubMed

Cooper RM, O’Sullivan E, Popat M, Behringer E, Hagberg CA. Difficult Airway Society guidelines for the management of tracheal extubation. Anaesthesia. 2013;68:217. https://doi.org/10.1111/anae.12139.CrossRefPubMed

Smailes ST, McVicar AJ, Martin R. Cough strength, secretions and extubation outcome in burn patients who have passed a spontaneous breathing trial. Burns. 2013;39:236–42. https://doi.org/10.1016/j.burns.2012.09.028.CrossRefPubMed

10.

Matilde INE, Eid RAC, Nunes AF, Ambrozin ARP, Moura RH, Carnieli-Cazati D, et al. Bronchial hygiene techniques in patients on mechanical ventilation: what are used and why? Einstein (São Paulo). 2018;16:eAO3856. https://doi.org/10.1590/s1679-45082018ao3856.CrossRef

11.

Lombardi FS, Cotoia A, Petta R, Schultz M, Cinnella G, Horn J. Prediction of extubation failure in Intensive Care Unit: systematic review of parameters investigated. Minerva Anestesiol. 2019;85:298–307. https://doi.org/10.23736/S0375-9393.18.12627-7.CrossRefPubMed

12.

Thille AW, Boissier F, Ben Ghezala H, Razazi K, Mekontso-Dessap A, Brun-Buisson C. Risk factors for and prediction by caregivers of extubation failure in ICU patients: a prospective study. Crit Care Med. 2015;43:613–20. https://doi.org/10.1097/CCM.0000000000000748.CrossRefPubMed

13.

Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A. Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med. 2006;173:164–70. https://doi.org/10.1164/rccm.200505-718OC.CrossRefPubMed

14.

Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have ly completed a spontaneous breathing trial. Chest. 2001;120:1262–70. https://doi.org/10.1378/chest.120.4.1262.CrossRefPubMed

15.

Smina M, Salam A, Khamiees M, Gada P, Amoateng-Adjepong Y, Manthous CA. Cough peak flows and extubation outcomes. Chest. 2003;124:262–8. https://doi.org/10.1378/chest.124.1.262.CrossRefPubMed

16.

Gonçalves MR, Honrado T, Winck JC, Paiva JA. Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial. Crit Care. 2012;16:R48. https://doi.org/10.1186/cc11249.CrossRefPubMedPubMedCentral

17.

Salam A, Tilluckdharry L, Amoateng-Adjepong Y, Manthous CA. Neurologic status, cough, secretions and extubation outcomes. Intensive Care Med. 2004;30:1334–9. https://doi.org/10.1007/s00134-004-2231-7.CrossRefPubMed

18.

Mokhlesi B, Tulaimat A, Gluckman TJ, Wang Y, Evans AT, Corbridge TC. Predicting extubation failure after completion of a spontaneous breathing trial. Respir Care. 2007;52:1710–7.PubMed

19.

Tulaimat A, Mokhlesi B. Accuracy and reliability of extubation decisions by intensivists. Respir Care. 2011;56:920–7. https://doi.org/10.4187/respcare.00851.CrossRefPubMed

20.

Wang TH, Wu CP, Wang LY. Chest physiotherapy with early mobilization may improve extubation outcome in critically ill patients in the intensive care units. Clin Respir J. 2018;12:2613–21. https://doi.org/10.1111/crj.12965.CrossRefPubMed

21.

De Jonghe B, Bastuji-Garin S, Durand MC, Malissin I, Rodrigues P, Cerf C, et al. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med. 2007;35:2007–15. https://doi.org/10.1097/01.ccm.0000281450.01881.d8.CrossRefPubMed

22.

De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288:2859–67. https://doi.org/10.1001/jama.288.22.2859.CrossRefPubMed

Title: Frequent tracheal suctioning is associated with extubation failure in patients with successful spontaneous breathing trial: a single-center retrospective cohort study
Authors: Junpei Haruna
Hiroomi Tatsumi
Satoshi Kazuma
Aki Sasaki
Yoshiki Masuda
Publication date: 01-12-2022
Publisher: Springer Berlin Heidelberg
Keyword: Expectoration
Published in: JA Clinical Reports / Issue 1/2022
Electronic ISSN: 2363-9024
DOI: https://doi.org/10.1186/s40981-022-00495-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Frequent tracheal suctioning is associated with extubation failure in patients with successful spontaneous breathing trial: a single-center retrospective cohort study

Abstract

Background

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

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