Factors associated with extubation failure in an intensive care unit: a case-control study.
Ana Beatriz Braga Arcanjo, Lúcia Marinilza Beccaria
PMID 36995853WHAT IT FOUND
Weak cough and positive fluid balance were associated with extubation failure in ICU patients.
Of 65 who failed, 39 underwent tracheostomy and 38 died. Do not read these factors as proven causes; the study was observational and cough was assessed subjectively.
Key findings
01Of 480 patients extubated following the institutional protocol, 65 failed within 48 hours and required reintubation.
02In the multivariate model, ineffective cough and higher fluid balance were associated with extubation failure.
03Among the 65 patients who failed extubation, 39 underwent tracheostomy and 38 died during hospitalization.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
Observational case-control design cannot prove that weak cough or positive fluid balance caused extubation failure. Single teaching hospital in two ICUs, so results may not generalise to other units. Cough effectiveness was judged subjectively by professionals, and the authors say some pre-extubation assessments were wrong. Fluid balance thresholds were not part of the institution's safe extubation protocol.
The easy way to misread this
Do not read weak cough and positive fluid balance as proven causes of extubation failure. The study is observational, and cough was assessed subjectively, so it cannot show that correcting either factor prevents reintubation.