Predictors Of Successful Extubation in Critically Ill Patients: Multicentre Observational Study (POSE)

Osaka University

Status: Completed

Conditions: Critical Care; Weaning; Liberation From Mechanical Ventilation; Mechanical Ventilation; Intubation; Extubation

Study type: Observational

Funder types: Other

Identifiers

NCT03185962

POSE

Details and patient eligibility

About

Extubation failure can directly worsen patient outcomes. Therefore, the decision to extubate is a critical moment during an intensive care unit (ICU) stay. The decision to extubate is usually made after a weaning readiness test involving spontaneous breathing on a T-piece or low levels of ventilatory assistance. However, extubation failure still occurs in 10 to 20% of patients. The investigators focused on previously reported physiological risk factors, and were able to obtain from common clinical practice: 1) age, 2) underlying cardiovascular disease, 3) underlying respiratory disease or occurrence of pneumonia, 4) rapid shallow breathing index (RSBI), 5) positive fluid balance during the previous 24 hours, 6) the ratio of arterial oxygen partial pressure to fractional inspired oxygen, 7) Glasgow Coma Scale, 8) respiratory tract secretions. The investigators aimed to assess the incidence and risk factors for extubation failure among critically ill patients who passed the 30 min spontaneous breathing test (SBT) using a low level of pressure support (PS) with positive end-expiratory pressure (PEEP), in a prospective multicenter study.

Full description

Primary Outcome Measures:

Reintubation within 48 hours after extubation (logistic regression will be used to assess the risk factors)

Secondary Outcome Measures:

• Use of non-invasive positive pressure ventilation or nasal high flow within 48 hours after extubation.
• Risk factors for extubation failure, with quantitative variables expressed as means (standard deviation) or medians (interquartiles 25%-75%) and compared using the student t test or Wilcoxon test as appropriate
• Length of ICU and hospital stay, vital status at ICU and hospital discharge, 28-day mortality

Enrollment: 499 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Mechanically ventilated for longer than 24 hours in Intensive Care Units
• Extubated after successful the 30 min spontaneous breathing test using a low level of pressure support with positive end-expiratory pressure

Exclusion criteria

• Decision not to reintubate
• Unplanned extubation
• Extracorporeal circulation
• Patients who died within 48 hours after extubation

Trial design

499 participants in 3 patient groups

Successful extubation

Description:

extubated successfully

Extubation failure

Description:

reintubated within 48 hours

NPPV/NHF

Description:

use of non-invasive positive pressure ventilation (NPPV) or nasal high flow (NHF) within 48 hours after extubation