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Ann Intensive Care. 2018 Feb 5;8(1):18. doi: 10.1186/s13613-018-0360-3.

Physiological predictors of respiratory and cough assistance needs after extubation.

Author information

1
INSERM, Université Grenoble-Alpes, U1042, HP2, 38000, Grenoble, France. nterzi@chu-grenoble.fr.
2
CHU Grenoble Alpes, Service de réanimation médicale, 38000, Grenoble, France. nterzi@chu-grenoble.fr.
3
Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France. nterzi@chu-grenoble.fr.
4
Université de Versailles Saint Quentin en Yvelines, INSERM U1179, Garches, France.
5
CIC 1429, INSERM, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.
6
Service d'Explorations Fonctionnelles Respiratoires, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.
7
Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France.
8
Service de Réanimation, Centre Hospitalier de Roanne, 42300, Roanne, France.
9
INSERM, U1075, 14000, Caen, France.
10
Université de Caen, 14000, Caen, France.
11
CHRU Caen, Service d'Explorations Fonctionnelles Respiratoire, 14000, Caen, France.
12
INSERM U 1179, Université de Versailles-Saint Quentin en Yvelines, 104 Bd Raymond Poincaré, 92380, Garches, France.
13
CIC 1429, Inserm-APHP, Hôpital Raymond Poincaré, 104 Bd Raymond Poincaré, 92380, Garches, France.
14
Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, BP 208, 50102, Cherbourg-en-Cotentin, France.
15
General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Laboratory of Inflammation and Infection, U1173, INSERM and University of Versailles SQY, 92380, Garches, France.
16
Unité de Biostatistique et de Recherche Clinique, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.
17
Pôle de ventilation à domicile, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.
18
Service de Santé Publique, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.

Abstract

BACKGROUND:

Identifying patients at high risk of post-extubation acute respiratory failure requiring respiratory or mechanical cough assistance remains challenging. Here, our primary aim was to evaluate the accuracy of easily collected parameters obtained before or just after extubation in predicting the risk of post-extubation acute respiratory failure requiring, at best, noninvasive mechanical ventilation (NIV) and/or mechanical cough assistance and, at worst, reintubation after extubation.

METHODS:

We conducted a multicenter prospective, open-label, observational study from April 2012 through April 2015. Patients who passed a weaning test after at least 72 h of endotracheal mechanical ventilation (MV) were included. Just before extubation, spirometry and maximal pressures were measured by a technician. The results were not disclosed to the bedside physicians. Patients were followed until discharge or death.

RESULTS:

Among 3458 patients admitted to the ICU, 730 received endotracheal MV for longer than 72 h and were then extubated; among these, 130 were included. At inclusion, the 130 patients had mean ICU stay and endotracheal MV durations both equal to 11 ± 4.2 days. After extubation, 36 patients required curative NIV, 7 both curative NIV and mechanical cough assistance, and 8 only mechanical cough assistance; 6 patients, all of whom first received NIV, required reintubation within 48 h. The group that required NIV after extubation had a significantly higher proportion of patients with chronic respiratory disease (P = 0.015), longer endotracheal MV duration at inclusion, and lower Medical Research Council (MRC) score (P = 0.02, P = 0.01, and P = 0.004, respectively). By multivariate analysis, forced vital capacity (FVC) and peak cough expiratory flow (PCEF) were independently associated with (NIV) and/or mechanical cough assistance and/or reintubation after extubation. Areas under the ROC curves for pre-extubation PCEF and FVC were 0.71 and 0.76, respectively.

CONCLUSION:

In conclusion, FVC measured before extubation correlates closely with FVC after extubation and may serve as an objective predictor of post-extubation respiratory failure requiring NIV and/or mechanical cough assistance and/or reintubation in heterogeneous populations of medical ICU patients. ClinicalTrials.gov as #NCT01564745.

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