Abstract
Introduction
Extubation failure is associated with negative outcomes making the identification of risk factors for failure paramount to patient selection. Burn patients experience a high incidence of respiratory failure requiring mechanical ventilation. There is no consensus on the acceptable rate of extubation failure and many conventional indices used in critical care do not accurately predict extubation outcome in burn patients. The purpose of this study was to examine the rate of extubation failure in the burned population and to examine the impact of inhalation injury, as well as other factors, on extubation outcome.
Methods
Burn patients from a single center over the period 2009–2017 were examined and included if they were intubated prior to arrival or within 48 hours of admission and underwent a planned extubation. Patients were excluded if they proceeded directly to tracheostomy, died prior to extubation, or experienced an unintentional extubation. From this cohort, a matched case-control analysis based on age, TBSA and gender was performed of patients who succeeded after extubation, defined as not requiring reintubation within 72 hours of extubation, to those who failed. Characteristics and clinical parameters were compared between these two groups to determine if any factor(s) could predict extubation failure.
Results
A 12.3% incidence of extubation failure was found in our cohort of 106 burn patients. In the matched case-control analysis of 48 extubation successes and 58 extubation failures, the presence of inhalation injury was surprisingly associated with extubation success as was a higher PaO2:FiO2 ratio immediately prior to extubation. Higher heart rate and lower serum pH was associated with extubation failure. ANCOVA analysis demonstrated that a sodium trending higher before extubation was associated with more successes, possibly indicative of a lower volume status.
Conclusions
Classic extubation criteria do not accurately predict extubation outcome in burn patients; analysis of other characteristics and clinical parameters may be able to provide better predictions. A constellation of these parameters needs to be studied prospectively.
Applicability of Research to Practice
Defining a constellation of parameters that can aid in identifying those at high risk of extubation failure could change practice.
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