Predictors Of Successful Extubation in Critically Ill Patients: Multicentre Observational Study

Study Overview
=================
Brief Summary
-----------------
Extubation failure can directly worsen patient outcomes. Therefore, the decision to extubate is a critical moment during an intensive care unit (ICU) stay. The decision to extubate is usually made after a weaning readiness test involving spontaneous breathing on a T-piece or low levels of ventilatory assistance. However, extubation failure still occurs in 10 to 20% of patients. The investigators focused on previously reported physiological risk factors, and were able to obtain from common clinical practice: 1) age, 2) underlying cardiovascular disease, 3) underlying respiratory disease or occurrence of pneumonia, 4) rapid shallow breathing index (RSBI), 5) positive fluid balance during the previous 24 hours, 6) the ratio of arterial oxygen partial pressure to fractional inspired oxygen, 7) Glasgow Coma Scale, 8) respiratory tract secretions. The investigators aimed to assess the incidence and risk factors for extubation failure among critically ill patients who passed the 30 min spontaneous breathing test (SBT) using a low level of pressure support (PS) with positive end-expiratory pressure (PEEP), in a prospective multicenter study.

Detailed Description
-----------------
Primary Outcome Measures: Reintubation within 48 hours after extubation (logistic regression will be used to assess the risk factors) Secondary Outcome Measures: Use of non-invasive positive pressure ventilation or nasal high flow within 48 hours after extubation. Risk factors for extubation failure, with quantitative variables expressed as means (standard deviation) or medians (interquartiles 25%-75%) and compared using the student t test or Wilcoxon test as appropriate Length of ICU and hospital stay, vital status at ICU and hospital discharge, 28-day mortality

Official Title
-----------------
Predictors Of Successful Extubation in Critically Ill Patients: Multicentre Observational Study

Conditions
-----------------
Intubation, Extubation, Weaning, Mechanical Ventilation, Liberation From Mechanical Ventilation, Critical Care

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Mechanically ventilated for longer than 24 hours in Intensive Care Units Extubated after successful the 30 min spontaneous breathing test using a low level of pressure support with positive end-expiratory pressure Exclusion Criteria: Decision not to reintubate Unplanned extubation Extracorporeal circulation Patients who died within 48 hours after extubation

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Successful extubation<br>extubated successfully | |
| Extubation failure<br>reintubated within 48 hours | |
| NPPV/NHF<br>use of non-invasive positive pressure ventilation (NPPV) or nasal high flow (NHF) within 48 hours after extubation | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Implementation of reintubation within 48 hours after extubation | logistic regression will be used to identify risk factors | 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Use of non-invasive positive pressure ventilation or nasal high flow within 48 hours after extubation | logistic regression will be used to identify risk factors | 48 hours | 
| Length of ICU and hospital stay, | mean(standard deviation) or medians (interquartiles 25%-75%) and compared using the student t test or Wilcoxon test as appropriate | 28 days | 
| vital status at ICU and hospital discharge, 28-day mortality | mean(standard deviation) or medians (interquartiles 25%-75%) and compared using the student t test or Wilcoxon test as appropriate | 28 days |