Postextubation fluid balance is associated with extubation failure: a cohort study.

Autor: Santos PAD; Departamento de Terapia Intensiva, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil., Ribas A; Departamento de Terapia Intensiva, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil., Quadros TCC; Departamento de Terapia Intensiva, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil., Blattner CN; Departamento de Terapia Intensiva, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil., Boniatti MM; Departamento de Terapia Intensiva, Hospital de Clínicas de Poto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.
Jazyk: Portuguese; English
Zdroj: Revista Brasileira de terapia intensiva [Rev Bras Ter Intensiva] 2021 Oct 25; Vol. 33 (3), pp. 422-427. Date of Electronic Publication: 2021 Oct 25 (Print Publication: 2021).
DOI: 10.5935/0103-507X.20210057
Abstrakt: Objective: To assess whether there is an association between 48-hour postextubation fluid balance and extubation failure.
Methods: This was a prospective cohort study that included patients admitted to the intensive care unit of a tertiary hospital in southern Brazil from March 2019 to December 2019. Patients who required mechanical ventilation for at least 24 hours and who were extubated during the study period were included. The primary outcome was extubation failure, considered as the need for reintubation in the first 72 hours after extubation. The secondary outcome was a combined outcome with extubation failure or the need for therapeutic noninvasive ventilation.
Results: A total of 101 patients were included. Extubation failure was observed in 29 (28.7%) patients. In univariate analysis, patients with a negative 48-hour postextubation fluid balance higher than one liter had a lower rate of extubation failure (12.0%) than patients with a negative 48-hour postextubation fluid balance lower than 1L (34.2%; p = 0.033). Mechanical ventilation duration and negative 48-hour postextubation fluid balance lower than one liter were associated with extubation failure when corrected for Simplified Acute Physiology Score 3 in multivariate analysis. When we evaluated the combined outcome, only negative 48-hour postextubation lower than 1L maintained an association when corrected for for Simplified Acute Physiology Score 3 and mechanical ventilation duration.
Conclusion: The 48-hour postextubation fluid balance is associated with extubation failure. Further studies are necessary to assess whether avoiding positive fluid balance in this period might improve weaning outcomes.
Databáze: MEDLINE
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