Risk factors for extubation failure in the intensive care unit

ABSTRACT Objective: To determine the risk factors for extubation failure in the intensive care unit. Methods: The present case-control study was conducted in an intensive care unit. Failed extubations were used as cases, while successful extubations were used as controls. Extubation failure was defined as reintubation being required within the first 48 hours of extubation. Results: Out of a total of 956 patients who were admitted to the intensive care unit, 826 were subjected to mechanical ventilation (86%). There were 30 failed extubations and 120 successful extubations. The proportion of failed extubations was 5.32%. The risk factors found for failed extubations were a prolonged length of mechanical ventilation of greater than 7 days (OR = 3.84, 95%CI = 1.01 - 14.56, p = 0.04), time in the intensive care unit (OR = 1.04, 95%CI = 1.00 - 1.09, p = 0.03) and the use of sedatives for longer than 5 days (OR = 4.81, 95%CI = 1.28 - 18.02; p = 0.02). Conclusion: Pediatric patients on mechanical ventilation were at greater risk of failed extubation if they spent more time in the intensive care unit and if they were subjected to prolonged mechanical ventilation (longer than 7 days) or greater amounts of sedative use.摘要 研究目的：明确重症监护病房（Intensive Care Unit, ICU）内拔管失败（extubation failure）的危险因素。 研究方法：本项病例对照研究（case-control study）于重症监护病房内开展，以拔管失败患者作为病例组，拔管成功患者作为对照组。本研究将拔管失败定义为拔管后48小时内需行重新气管插管（reintubation）。 研究结果：共计纳入956例重症监护病房收治患者，其中826例接受机械通气（mechanical ventilation）治疗，占比86%。最终纳入病例组30例拔管失败患者、对照组120例拔管成功患者，拔管失败率为5.32%。本研究筛选出的拔管失败危险因素包括：机械通气时长超过7天（比值比（odds ratio, OR）=3.84，95%置信区间（confidence interval, CI）=1.01~14.56，P=0.04）、重症监护病房停留时长（OR=1.04，95%CI=1.00~1.09，P=0.03）以及镇静剂（sedatives）使用时长超过5天（OR=4.81，95%CI=1.28~18.02；P=0.02）。 研究结论：接受机械通气的儿科患者（pediatric patients），若重症监护病房停留时间更长、机械通气时长超过7天，或镇静剂使用量更大，则拔管失败风险更高。