Predictors of need of mechanical ventilation and reintubation in patients with acute respiratory failure secondary to chronic obstructive pulmonary disease
Amit Banga, G. C. Khilnani, S. K. Sharma
Acute exacerbation, APACHE II score, CO 2 narcosis, PaCO 2
Citation Information :
Banga A, Khilnani GC, Sharma SK. Predictors of need of mechanical ventilation and reintubation in patients with acute respiratory failure secondary to chronic obstructive pulmonary disease. Indian J Crit Care Med 2006; 10 (2):88-94.
Background and Aims: To identify predictors of need of mechanical ventilation (MV) and that of reintubation, after a planned extubation, among the patients with exacerbation of chronic obstructive pulmonary disease. Materials and Methods: Prospectively collected data of 82 patients with exacerbation of COPD over a one-year period were reviewed. Clinical and demographic profile, APACHE II score, blood gas parameters and serum biochemistry, recorded at the time of admission, were compared between patients who required MV and those who did not. Parameters were also compared between the groups formed on the basis of requirement of reintubation. Results: Sixty-nine patients (84.1%) required invasive MV. Independent predictors of need of MV were pH< 7.26 (adjusted OR, 95% CI) (4.9, 1.1-21.3; P =0.03) and SA < 3.5 g/dL (6.3, 1.4-27.7; P =0.01). Reintubation was required in 8 patients out of 45, who were extubated (17.8%). PaCO2 rise 12 hours after extubation (1.25, 1.0-1.5; P =0.01) and APACHE II score (1.33, 1.0-1.7; P =0.03) were independent predictors for need of reintubation. A cut off level of 7.2 mmHg for PaCO2 rise had sensitivity of 100% and specificity of 84%, for need of reintubation. Conclusions: Presence of acidemia and hypoalbuminemia at admission are predictors of need of MV, whereas APACHE II score at baseline and PaCO2 rise in the initial 12 hours after extubation, predict need of reintubation.
Kinare SG, Dave KM, Sheth RA. Incidence of emphysema in Bombay. Indian J Med Res 1981;74:273-82.
Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Chronic obstructive pulmonary disease surveillance-United States, 1971-2000. Respir Care 2002;47:1184-99.
Andersson F, Borg S, Jansson SA, Jonsson AC, Ericsson A, Prutz C, et al. The costs of exacerbations in chronic obstructive pulmonary disease (COPD). Respir Med 2002;96:700-8.
Schonhofer B, Euteneuer S, Nava S, Suchi S, Kohler D. Survival of mechanically ventilated patients admitted to a specialised weaning centre. Intensive Care Med 2001;28:908-16.
Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;112:186-92.
American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease and asthma. Am Rev Respir Dis 1987;136:225-44.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
Pingleton SK, Fagon JY, Leeper KV Jr. Patient selection for clinical investigation of ventilator-Associated pneumonia: Criteria for evaluating diagnostic techniques. Chest 1992;102:553S-6S.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Am J Respir Crit Care Med 1994;149:818-24.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. ACCP/SCCM Consensus Conference. Chest 1992;101:1644-55.
Brochard L, Moncebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al. Non invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333:817-22.
British Thoracic Society Standards of Care Subcommittee. Non-invasive ventilation in acute respiratory failure. Thorax 2002;57:192-211.
Weiss SM, Hudson LD. Outcome from respiratory failure. Crit Care Clin 1994;10:197-215.
Soo Hoo GW, Hakiman I, Santiago SM. Hypercapnic respiratory failure in COPD patients. Response to therapy. Chest 2000;117:169-77.
Plant PK, Owen JL, Elliott MW. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: Long term survival and predictors of in-hospital outcome. Thorax 2001;56:708-12.
Breen D, Churches T, Hawker F, Torzillo PJ. Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: A long term follow up study. Thorax 2002;57:29-33.
Boosalis MG, Ott L, Levine AS, Slag MF, Morley JE, Young B, et al. Relationship of visceral proteins to nutritional status in chronic and acute stress. Crit Care Med 1989;17:741-7.
Vitacca M, Clini E, Porta R, Foglio K, Ambrosino N. Acute exacerbations in patients with COPD: Predictors of need for mechanical ventilation. Eur Respir J 1996;9:1487-93.
Rice-Evans C, Miller NJ. Measurement of antioxidant capacity in biological fluids. Methods Enzymol 1994;234:279-84.
Miller NJ, Rice-Evans CA. Spectrophotometric determination of antioxidant activity. Redox Rep 1996;2:161-71.
Margarson MP, Soni NC. Effects of albumin supplementation on microvascular permeability in septic patients. J Appl Physiol 2002;92:2139-45.
Foley EF, Borlase BC, Dzik WH, Bistrian BR, Benotti PN. Albumin supplementation in the critically ill. A prospective, randomized trial. Arch Surg 1990;125:739-42.
de Lassence A, Alberti C, Azoulay E, Le Miere E, Cheval C, Vincent F, et al. Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: A prospective multicenter study. Anesthesiology 2002;97:148-56.
Toomtong P, Raksakietisak M, Vorakitpokatorn P. Clinical outcomes of failed extubation in a postoperative intensive care unit. J Med Assoc Thai 2002;85:S987-92.
Ibrahim EH, Tracy L, Hill C, Fraser VJ, Kollef MH. The occurrence of ventilator-associated pneumonia in a community hospital: Risk factors and clinical outcomes. Chest 2001;120:555-61.
Epstein SK. Predicting extubation failure: Is it in (on) the cards? Chest 2001;120:1061-3.
Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998;158:489-93.
Epstein SK. Endotracheal extubation. Respir Care Clin North Am 2000;6:321-60.
Jacob B, Chatila W, Manthous CA. The unassisted respiratory rate: Tidal volume ratio accurately predicts weaning outcome in post-operative patients. Crit Care Med 1996;25:253-7.
Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 2001;120:1262-70.