American journal of surgery · 2025
Standard spontaneous breathing trial parameters may not predict unplanned reintubation for trauma patients.
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Given Caroline, Chang Melissa, Dunn Natassia, Grigorian Areg, Alvarez Claudia, Burruss Sigrid, Chin Theresa, Kuza Catherine, Nahmias Jeffry
Аннотация
BACKGROUND: The applicability of spontaneous breathing trial (SBT) factors such as negative inspiratory force (NIF) and rapid shallow breathing index (RSBI) as predictors of reintubation in trauma patients (TPs) is unclear. This study aimed to identify predictors of unplanned reintubation (UR) in TPs.
METHODS: A single center, retrospective (1/2017-12/2023) study of TPs ≥18 years-old extubated from endotracheal mechanical ventilation was performed. Patients with UR during admission were compared to patients without UR. A multivariable logistic regression was performed to identify risk factors associated with UR.
RESULTS: 39 of 424 TPs (9.2 %) had UR. UR patients were older (median: 55 vs 39 years-old, p = 0.012) and more often had congestive heart failure (10.3 % vs 1.6 %, p < 0.001), cirrhosis (7.7 % vs 1.9 %, p = 0.025), end stage renal disease (7.7 % vs 1.6 %, p = 0.044), and a higher injury severity scores (ISS) (median: 27 vs 18, p < 0.001). UR patients had increased ventilator days (median: 6 vs 2, p < 0.001) prior to extubation, whereas RSBI and NIF were similar (median: 36 vs 32, p = 0.508) and (median: -24.0 vs -27.0 cm H2O, p = 0.190). On multivariable analysis, RSBI <50 or <105 and NIF < -20 were not associated with UR. Age (OR 1.03, CI 1.01-1.05, p = 0.006) and ISS (OR 1.04, CI 1.01-1.08, p = 0.022) were independently associated with increased risk of UR.
CONCLUSIONS: SBT parameters (RSBI and NIF) were not associated with UR. Age and ISS were independently associated with UR. This suggests additional patient-specific factors should help guide extubation decisions for TPs.
METHODS: A single center, retrospective (1/2017-12/2023) study of TPs ≥18 years-old extubated from endotracheal mechanical ventilation was performed. Patients with UR during admission were compared to patients without UR. A multivariable logistic regression was performed to identify risk factors associated with UR.
RESULTS: 39 of 424 TPs (9.2 %) had UR. UR patients were older (median: 55 vs 39 years-old, p = 0.012) and more often had congestive heart failure (10.3 % vs 1.6 %, p < 0.001), cirrhosis (7.7 % vs 1.9 %, p = 0.025), end stage renal disease (7.7 % vs 1.6 %, p = 0.044), and a higher injury severity scores (ISS) (median: 27 vs 18, p < 0.001). UR patients had increased ventilator days (median: 6 vs 2, p < 0.001) prior to extubation, whereas RSBI and NIF were similar (median: 36 vs 32, p = 0.508) and (median: -24.0 vs -27.0 cm H2O, p = 0.190). On multivariable analysis, RSBI <50 or <105 and NIF < -20 were not associated with UR. Age (OR 1.03, CI 1.01-1.05, p = 0.006) and ISS (OR 1.04, CI 1.01-1.08, p = 0.022) were independently associated with increased risk of UR.
CONCLUSIONS: SBT parameters (RSBI and NIF) were not associated with UR. Age and ISS were independently associated with UR. This suggests additional patient-specific factors should help guide extubation decisions for TPs.