Predicting extubation failure

Results Out of 680 intubations, 73(11%) patients [46 (63%) male] had failed extubations. Average age was 60(21-88) years. Average time to re-intubation was 22.1(1-72) hours, 45(62%) being re-intubated at≤24 hours. Average time intubated was 2.2 days with 3 patients intubated for >7 days. Fifteen(21%) patients had had no sedation within 4 hours of extubation. All others had one or more of fentanyl, Remifentanil, propofol, midazolam, and morphine. Eighteen (25%) patients had a Glasgow Coma score(GCS) < 10(eyes 4, voice 1, motor 5), of which 16(89%) were on at least one sedative. Five patients did not have GCS recorded. Forty-four (60%) patients had mucoid secretions, the rest having thick, purulent or yellow secretions. Mean respiratory rate(RR) was 19/minute (range 9-39) with mean rapid shallow breathing index (RSBI) f/Vt 37.5 breaths/min/l (10.8 203.1). Eight (11%) patients had FiO2 >40% pre-extubation. Mean pre-extubation PEEP was 5.8cmH2O(5-10) with mean pressure support(PS) of 14cmH2O (range 5-27), with 57(78%) having PS >10. Fifty eight(80%) patients were hypercapnoeic(PaCO2 >45mmHg) pre-extubation, 2 patients had no arterial blood gas documented shortly prior to extubation, 1 with venous sample. Of these 58 patients, 5 (9%) were acidotic and 8 (14%) received NIV (6 CPAP, 2 BIPAP) immediately post extubation. One patient self-extubated. Post extubation ABG showed 15/58 (26%) had respiratory acidosis (PH < 7.35, PaCO2 ≥ 60mmHg), 3 of which received NIV immediately post extubation.