Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul-Sep;12(3):216-222.
doi: 10.4103/sjmms.sjmms_19_24. Epub 2024 Jun 20.

Independent Risk Factors of Failed Extubation among Adult Critically Ill Patients: A Prospective Observational Study from Saudi Arabia

Aqeel Hamad Al-Ali  1 , Khalid Abdullah Alraeyes  1 , Princess Rhea Julkarnain  1 , Arul Prasath Lakshmanan  1 , Alzahra Alobaid  1 , Ahmed Yahya Aljoni  1 , Nada Hadi Saleem  1 , Mohammed Ali Al Odat  2 , Waleed Tharwat Aletreby  2
Affiliations

Independent Risk Factors of Failed Extubation among Adult Critically Ill Patients: A Prospective Observational Study from Saudi Arabia

Aqeel Hamad Al-Ali et al. Saudi J Med Med Sci. 2024 Jul-Sep.

Abstract

Background: Mechanical ventilation provides essential support for critically ill patients in several diagnoses; however, extubation failure can affect patient outcomes. From Saudi Arabia, no study has assessed the factors associated with extubation failure in adults.

Methods: This prospective observational study was conducted in the intensive care unit of a tertiary care hospital in Riyadh, Saudi Arabia. Adult patients who had been mechanically ventilated via the endotracheal tube for a minimum of 24 hours and then extubated according to the weaning protocol were included. Failed extubation was defined as reintubation within 48 hours of extubation.

Results: A total of 505 patients were included, of which 72 patients had failed extubation (14.3%, 95% CI: 11.4%-17.7%). Compared with the failed extubation group, the successfully extubated group had significantly shorter duration of mechanical ventilation (mean difference: -2.6 days, 95% CI: -4.3 to -1; P = 0.001), a slower respiratory rate at the time of extubation (mean difference: -2.3 breath/min, 95% CI: -3.8 to -1; P = 0.0005), higher pH (mean difference: 0.02, 95% CI: 0.001-0.04; P = 0.03), and more patients with strong cough (percent difference: 17.7%, 95% CI: 4.8%-30.5%; P = 0.02). Independent risk factors of failed extubation were age (aOR = 1.02; 95% CI: 1.002-1.03; P = 0.03), respiratory rate (aOR = 1.06, 95% CI: 1.01-1.1; P = 0.008), duration of mechanical ventilation (aOR = 1.08, 95% CI: 1.03 - 1.1; P < 0.001), and pH (aOR = 0.02, 95% CI: 0.0006-0.5; P = 0.02).

Conclusion: Older age, longer duration of mechanical ventilation, faster respiratory rate, and lower pH were found to be independent risk factors that significantly increased the odds of extubation failure among adults.

Keywords: Adverse effects; airway extubation; critically ill; mechanical ventilation; reintubation; risk factors.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Patients’ enrollment flow diagram
Figure 2
Figure 2
Intubation indications in the study groups. TBI – traumatic brain injury; CVA – cerebrovascular accident; “Other” includes intoxication, burn, seizures, and upper gastrointestinal bleeding. Chi-square test of association: P = 0.97
Figure 3
Figure 3
Calibration belt of logistic regression predictive ability
See this image and copyright information in PMC

References

    1. Cheng AC, Cheng KC, Chen CM, Hsing SC, Sung MY. The outcome and predictors of failed extubation in intensive care patients – The elderly is an important predictor. Int J Gerontol. 2011;5:206–11.
    1. Buczko W. Ventilator-associated pneumonia among elderly Medicare beneficiaries in long-term care hospitals. Health Care Financ Rev. 2010;31:1–10. - PMC - PubMed
    1. Saugel B, Rakette P, Hapfelmeier A, Schultheiss C, Phillip V, Thies P, et al. Prediction of extubation failure in medical intensive care unit patients. J Crit Care. 2012;27:571–7. - PubMed
    1. Kulkarni AP, Agarwal V. Extubation failure in intensive care unit: Predictors and management. Indian J Crit Care Med. 2008;12:1–9. - PMC - PubMed
    1. Xie J, Cheng G, Zheng Z, Luo H, Ooi OC. To extubate or not to extubate: Risk factors for extubation failure and deterioration with further mechanical ventilation. J Card Surg. 2019;34(10):1004–11. - PubMed

LinkOut - more resources