End-stage renal disease, cardiovascular failure predict extubation failure in obese patients
Cardiovascular system-related respiratory failure, low maximal inspiratory pressure (MIP) and end-stage renal disease (ESRD) are correlated with the risk of extubation failure in obese patients, a new study has found.
Medical records of 595 adult obese patients (mean age 63.6±15.8 years; 67.7 percent male) who required mechanical ventilation and were scheduled for extubation were used in the study. Those without available weight and height data were excluded. Student’s t-test was used to determine the differences between successful and failed extubation cases, while multivariate logistic regression was used to determine variables that predict successful extubation.
Of the patients, 5.7 percent (n=34) experienced failed extubation. The most common cause of failure was haemodynamic instability (n=10). This was followed by excess secretions (n=8), upper airway obstructions (n=8), oxygen failure (n=6) and encephalopathy (n=2).
Those who had failed extubation were significantly older (p=0.004), had higher blood urea nitrogen (p=0.04), more ESRD (p<0.001), less negative MIP (p=0.001) and less positive maximum expiratory pressure (MEP; p=0.001).
Respiratory failure because of cardiovascular system failure (p=0.002) and mortality rates in the intensive care unit (p<0.001) and at 28 days (p<0.001) were also significantly higher in the failed extubation group.
Multivariate logistic regression showed that lower MIP levels (odds ratio [OR], 0.94; 95 percent CI, 0.90 to 0.97; p=0.001), ESRD (OR, 14.0; 6.21 to 31.35; p<0.001) and respiratory failure because of cardiovascular failure (OR, 2.60; 1.16 to 5.80; p=0.02) were significantly tied to higher risks of extubation failure.