• Gac Med Mex · Jan 2020

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

    • Martín Santibañez-Velázquez, Gabriela Medina-García, and María E Ocharán-Hernández.
    • Specialty Hospital, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social.
    • Gac Med Mex. 2020 Jan 1; 156 (6): 539-545.

    IntroductionEven with an adequate mechanical ventilation weaning (MVW) protocol, the procedure fails in 15 to 30 % of cases.ObjectiveTo assess the association between independent risk factors (IRFs) and post-extubation failure in patients undergoing MVW in an intensive care unit.MethodLongitudinal, 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.Results123 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).ConclusionsIdentifying independent risk factors prior to MVW can help reduce the risk of extubation failure and associated morbidity and mortality.IntroducciónAun con adecuado protocolo de desconexión de la ventilación mecánica (DVM), el procedimiento falla en 15 a 30 % de los casos.ObjetivoEvaluar la asociación entre factores de riesgo independientes y fracaso posextubación en pacientes con DVM en una unidad de cuidados intensivos.MétodoEstudio de cohorte, longitudinal, prospectivo, analítico, que incluyó pacientes sometidos a ventilación mecánica por más de 24 horas y que fueron extubados. Se obtuvieron reportes preextubación de hemoglobina, albúmina, fósforo, índice cintura-cadera y puntuación SOFA. Se definió como fracaso de extubación al reinicio de la ventilación mecánica en 48 horas o menos.ResultadosSe extubaron 123 pacientes, 74 hombres (60 %); la edad promedio fue de 50 ± 18 años. Ocurrió fracaso de extubación en 37 (30 %). Como factores de riesgo independentes se asoció 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 más factores de riesgo independientes en 22.7 % (RR = 1.51, IC 95 % = 1.14-2.00).ConclusionesIdentificar los factores de riesgo independentes antes de la DVM puede ayudar a reducir el fracaso de la extubación y la morbimortalidad asociada.Copyright: © 2020 Permanyer.

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