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Patients’ prediction of extubation success

Andreas Perren| Marco Previsdomini| Michael Llamas| Bernard Cerutti| Sandor Györik| Giorgio Merlani| Philippe Jolliet
Original
Volume 36, Issue 12 / December , 2010

Pages 2045 - 2052

Abstract

Purpose

The spontaneous breathing trial (SBT)—relying on objective criteria assessed by the clinician—is the major diagnostic tool to determine if patients can be successfully extubated. However, little is known regarding the patient’s subjective perception of autonomous breathing.

Methods

We performed a prospective observational study in 211 mechanically ventilated adult patients successfully completing a SBT. Patients were randomly assigned to be interviewed during this trial regarding their prediction of extubation success. We compared post-extubation outcomes in three patient groups: patients confident (confidents; n = 115) or not (non-confidents; n = 38) of their extubation success and patients not subjected to interview (control group; n = 58).

Results

Extubation success was more frequent in confidents than in non-confidents (90 vs. 45%; p < 0.001/positive likelihood ratio = 2.00) or in the control group (90 vs. 78%; p = 0.04). On the contrary, extubation failure was more common in non-confidents than in confidents (55 vs. 10%; p < 0.001/negative likelihood ratio = 0.19). Logistic regression analysis showed that extubation success was associated with patient’s prediction [OR (95% CI): 9.2 (3.74–22.42) for confidentsvs.non-confidents] as well as to age [0.72 (0.66–0.78) for age 75 vs. 65 and 1.31 (1.28–1.51) for age 55 vs. 65].

Conclusions

Our data suggest that at the end of a sustained SBT, extubation success might be correlated to the patients’ subjective perception of autonomous breathing. The results of this study should be confirmed by a large multicenter trial.

Keywords

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