Extubation Failure in a Burn Intensive Care Unit: Examination of Contributing Factors.

Autor:	Rizzo JA; United States Army Institute of Surgical Research, Fort Sam Houston, Texas.; Uniformed Services University of Health Sciences, Bethesda, Maryland., Haq M; United States Army Institute of Surgical Research, Fort Sam Houston, Texas.; Metis Foundation, San Antonio Texas., McMahon RA; Brooke Army Medical Center, Fort Sam Houston, Texas.; United States Army Medical Center of Excellence, Joint Base San Antonio, Texas., Aden JK; Brooke Army Medical Center, Fort Sam Houston, Texas., Brillhart DB; Darnell Army Medical Center, Fort Hood, Texas., Cancio LC; United States Army Institute of Surgical Research, Fort Sam Houston, Texas.
Jazyk:	angličtina
Zdroj:	Journal of burn care & research : official publication of the American Burn Association [J Burn Care Res] 2021 Mar 04; Vol. 42 (2), pp. 177-181.
DOI:	10.1093/jbcr/iraa162
Abstrakt:	Extubation failure is associated with negative outcomes making the identification of risk factors for failure paramount. 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 do not accurately predict extubation outcomes 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 factors on extubation outcomes. Burn patients from a single center over 9 years were examined and included if they were intubated prior to arrival or within 48 hours of admission and underwent a planned extubation. From this cohort, a matched case-control analysis based on age, TBSA, and sex was performed of patients who succeeded after extubation, defined as not requiring reintubation within 72 hours, to those who failed. Characteristics and clinical parameters were compared to determine whether any factors could predict extubation failure. There was a 12.3% incidence of extubation failure. In the matched case-control analysis, the presence of inhalation injury was associated with extubation success. Higher heart rate and lower serum pH were 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. Classic extubation criteria do not accurately predict extubation outcomes in burn patients; analysis of other parameters may be able to provide better predictions. A constellation of these parameters needs to be studied prospectively. (Published by Oxford University Press on behalf of the American Burn Association 2020.)
Databáze:	MEDLINE
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