Minute Ventilation Recovery Time Measured Using a New, Simplified Methodology Predicts Extubation Outcome

    loading  Checking for direct PDF access through Ovid


Extubation failure is associated with poor intensive care unit and hospital outcomes. Minute ventilation recovery time, an integrative measure of a patient's respiratory reserve, has been shown in a pilot study to predict extubation outcome; however, the methodology is subjective and impractical for routine use. The authors hypothesize that minute ventilation recovery time, measured using an objective and simpler method, would predict extubation outcome. A prospective cohort study was performed in adult medical and surgical intensive care unit patients intubated for >24 hours who were weaning from mechanical ventilation. Minute ventilation recovery time was measured using a new, simplified, and objective method following the final spontaneous breathing trial prior to extubation. The primary outcome was extubation failure, defined as reintubation within 7 days. The study cohort comprised 88 patients, of whom 22 (25%) failed extubation after a median of 3 days. Demographic data, weaning parameters, and the proportion of patients who passed an extubation screen were similar between groups (P > .05). Minute ventilation recovery time was significantly longer in patients who failed extubation (15 [5–15] vs 2 [1–5] minutes, P < .001), consistent in both medical and surgical subgroups. Operating characteristics for a preliminary threshold (minute ventilation recovery time ≥5 minutes) for prediction of extubation failure were sensitivity = 0.78, specificity = 0.71, positive predictive value = 0.47, negative predictive value = 0.90, correctly classified = 0.72. Adjustment for significant covariates did not alter the relationship between minute ventilation recovery time ≥5 minutes and extubation failure (odds ratio = 4.9, 95% confidence interval 1.45–16.2, P < .02). C statistic was 0.79 ± 0.17. It was concluded that minute ventilation recovery time, measured using a feasible methodology, can predict extubation outcome in medical and surgical intensive care unit patients.

    loading  Loading Related Articles