Análise dos pacientes extubados no centro de terapia intensiva do Hospital Clementino Fraga Filho

Abstract

This study aims to evaluate the factors associated with extubation failures in extubated patients in the ICU of the Clementino Fraga Filho University Hospital with more than 48 hours of mechanical ventilation. Methodology: A retrospective chart review study analyzed 128 patients, corresponding to all patients admitted from June 2023 to December 2024 who remained on mechanical ventilation for 48 hours or more. Their baseline characteristics (gender, nature of admission, medical vs. surgical, obesity, low weight, SAPS on admission, SOFA on admission, lung disease, CHF, neurocritical illness, and neuromuscular disease) were assessed, and these were correlated with the failure to perform SBT and relevant outcomes. Subsequently, in patients who underwent at least one SBT, baseline characteristics, presence of infection and pneumonia, and mechanisms of failure (upper airway obstruction, bronchospasm, hypoxemia, hypercapnia, impaired secretion management, pulmonary congestion, muscle weakness, neurocognitive dysfunction, hemodynamic instability, symptomatic hypertension, arrhythmias, and "other" (endocrine and electrolyte disturbances)) of SBT were correlated with failure to perform an extubation attempt. The causes of SBT failure and the Glasgow Coma Scale at the first SBT were also investigated. Finally, in the cohort of patients who underwent an extubation attempt, baseline characteristics, mechanisms, presence of infection, and causes of extubation failure (cardiac, respiratory, neuropsychiatric, neuromuscular, and endocrine-metabolic causes) were analyzed. Characteristics on the day of extubation were also assessed (SOFA, fluid balance, and hemoglobin). The variables were correlated with extubation failure and outcomes (tracheostomy, duration of mechanical ventilation, length of hospital stay, and death). Extubation failure was defined as reintubation within 7 days. Results: Of the 128 patients, 75 (57%) underwent at least one SBT. Forty-five (35%) patients underwent an extubation attempt, with 13 failures. Patients who failed within 7 days had an 84.6% mortality rate. Extubation failure correlated with death even when analyzing only patients with extubation failure between 48 hours and 7 days. Hypoxemia, hemodynamic instability, cardiac, and respiratory causes correlated with extubation failure. Glasgow Coma score at the time of the first SBT correlated with extubation failure. Neuropsychological causes of failure predominated in the first SBT. Baseline characteristics or characteristics on the day of extubation did not correlate with extubation failure. Muscle weakness, hypoxemia, and hemodynamic instability correlated with death. Completion of and time to extubation correlated with survival. Respiratory failure was the most common presentation of extubation failure, followed by hemodynamic shock and, subsequently, cardiac arrest. Conclusion: Extubation failure within 7 days is associated with a significant increase in mortality, and the various mechanisms involved imply diverse prognostic considerations.