Association of independent risk factors with post-extubation failure in patients undergoing mechanical ventilation weaning

INTRODUCTION Even with an adequate mechanical ventilation weaning (MVW) protocol, the procedure fails in 15 to 30 % of cases. OBJECTIVE To assess the association between independent risk factors (IRFs) and post-extubation failure in patients undergoing MVW in an intensive care unit. METHOD Longitudinal, prospective, analytical cohort study in patients on mechanical ventilation for more than 24 hours and who were extubated. Pre-extubation reports of hemoglobin, albumin, phosphorus, waist-hip ratio and SOFA score were obtained. Extubation failure was defined as resumption of mechanical ventilation within 48 hours or less. RESULTS 123 patients were extubated, out of whom 74 were males (60 %); average age was 50 ± 18 years. Extubation failure occurred in 37 (30 %). Hypoalbuminemia was associated as an independent risk factor in 29 (23.8 %, RR = 1.43, 95 % CI = 1.11-1.85) and hypophosphatemia was in 18 (14.6 %, RR = 2.98, 95 % CI = 1.66-5.35); two or more IRFs were observed in 22.7 % (RR = 1.51, 95 % CI = 1.14-2.00). CONCLUSIONS Identifying independent risk factors prior to MVW can help reduce the risk of extubation failure and associated morbidity and mortality. INTRODUCCION Aun con adecuado protocolo de desconexion de la ventilacion mecanica (DVM), el procedimiento falla en 15 a 30 % de los casos. OBJETIVO Evaluar la asociacion entre factores de riesgo independientes y fracaso posextubacion en pacientes con DVM en una unidad de cuidados intensivos. METODO Estudio de cohorte, longitudinal, prospectivo, analitico, que incluyo pacientes sometidos a ventilacion mecanica por mas de 24 horas y que fueron extubados. Se obtuvieron reportes preextubacion de hemoglobina, albumina, fosforo, indice cintura-cadera y puntuacion SOFA. Se definio como fracaso de extubacion al reinicio de la ventilacion mecanica en 48 horas o menos. RESULTADOS Se extubaron 123 pacientes, 74 hombres (60 %); la edad promedio fue de 50 ± 18 anos. Ocurrio fracaso de extubacion en 37 (30 %). Como factores de riesgo independentes se asocio hipoalbuminemia en 29 (23.8 %, RR = 1.43, IC 95 % = 1.11-1.85) e hipofosfatemia en 18 (14.6 %, RR = 2.98, IC 95 % = 1.66-5.35); se observaron dos o mas factores de riesgo independientes en 22.7 % (RR = 1.51, IC 95 % = 1.14-2.00). CONCLUSIONES Identificar los factores de riesgo independentes antes de la DVM puede ayudar a reducir el fracaso de la extubacion y la morbimortalidad asociada.