Lung-thorax compliance measured during a spontaneous breathing trial is a good index of extubation failure in the surgical intensive care unit: a retrospective cohort study

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URI http://shark.lib.kagawa-u.ac.jp/kuir/metadata/28671
Title
Lung-thorax compliance measured during a spontaneous breathing trial is a good index of extubation failure in the surgical intensive care unit: a retrospective cohort study
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Description

Abstract
Background:

Extubation failure is associated with mortality and morbidity in the intensive care unit. Ventilator weaning protocols have been introduced, and extubation is conducted based on the results of a spontaneous breathing trial. Room for improvement still exists in extubation management, and additional objective indices may improve the safety of the weaning and extubation process. Static lung-thorax compliance reflects lung expansion difficulty that is caused by several conditions, such as atelectasis, fibrosis, and pleural effusion. Nevertheless, it is not used commonly in the weaning and extubation process. In this study, we investigated whether lung-thorax compliance is a good index of extubation failure in adults even when patients pass a spontaneous breathing trial.
Methods:

In a single-center, retrospective cohort study, patients over 18 years of age were mechanically ventilated, weaned with proportional assist ventilation, and underwent a spontaneous breathing trial process in surgical intensive care units of Kagawa University Hospital from July 2014 to June 2016. Extubation failure was the outcome measure of the study. We defined extubation failures as when patients were reintubated or underwent non-invasive positive-pressure ventilation within 24 h after extubation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the clinical involvement of several parameters. The area under the curve (AUC) was calculated to assess the discriminative power of the parameters.
Results:

We analyzed 173 patients and compared the success and failure groups. Most patients (162, 93.6%) were extubated successfully, and extubation failed in 11 patients (6.4%). The averages of lung-thorax compliance values in the success and failure groups were 71.9 ± 23.0 and 43.3 ± 14.6 mL/cmH2O, respectively, and were significantly different (p < 0.0001). In the ROC curve analysis, the AUC was highest for lung-thorax compliance (0.862), followed by the respiratory rate (0.821), rapid shallow breathing index (0.781), Acute Physiology and Chronic Health Evaluation II score (0.72), heart rate (0.715), and tidal volume (0.695).
Conclusions:

Lung-thorax compliance measured during a spontaneous breathing trial is a potential indicator of extubation failure in postoperative patients.

KEYWORDS:

Extubation failure; Lung and thorax compliance; Proportional assist ventilation; Spontaneous breathing trial

(医博甲707)

Author
著者 岡部 悠吾
著者(ヨミ) オカベ ユウゴ
著者(別表記) Okabe Yugo
Publication Title
Journal of Intensive Care
Publication Title Alternative
J Intensive Care.
Volume
6
Start Page
44
End Page
52
Publisher
Japanese Society of Intensive Care Medicine
日本集中医療医学会
BMC (part of Springer Nature)
Publisher Aalternative
日本集中医療医学会
Published Date
2018-07-31
ISSN
2052-0492
PMID
30083347
DOI
10.1186/s40560-018-0313-9
Resource Type
Thesis or Dissertation
Language
eng
Relation
出版社版DOIリンク(URL): https://doi.org/10.1186/s40560-018-0313-9
PMCID: PMC6069862
Resource URL
https://doi.org/10.1186/s40560-018-0313-9
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069862/
Relation(isVersionOf)
Publisher's Version
Rights
Copyright © The Author(s). 2018
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
DOI: https://doi.org/10.1186/s40560-018-0313-9
Text Version
ETD
Grant ID
博甲第707号
Grant Date
2019-03-24
Degree Name
博士(医学)
Grantor
香川大学
Set
香川大学
Copyright (C) 2009 Kagawa University All rights reserved.