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PULMONOLOGY / CLINICAL RESEARCH
Intra-abdominal pressure for predicating extubation failure in mechanically ventilated patients: it does work
1
Department of Nursing, Changshu First People’s Hospital, Soochow, China
2
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Soochow, China
3
Department of Nursing, Dushu Lake Hospital Affiliated to Soochow University, Soochow, China
Submission date: 2021-07-27
Final revision date: 2021-08-30
Acceptance date: 2021-09-01
Online publication date: 2021-09-17
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Reducing extubation failure is vital to the early recovery of pa- tients with mechanical ventilation (MV). We aimed to explore the predictive value of the change of intra-abdominal pressure (ΔIAP) before extubation for the extubation failure of MV patients.
Material and methods:
failure of MV patients. Material and methods: Patients undergoing MV for more than 24 h were selected. We used a urodynamic monitor to measure ΔIAP 30 min before extubation. The characteristics and prognosis of MV patients were analyzed. A receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of ΔIAP for extubation failure.
Results:
A total of 173 MV patients were included. The risks of extubation failure increased with the decrease of ΔIAP. The risk of extubation failure in the ΔIAP ≤ 21 mm Hg group was 5.7 times that of the ΔIAP ≥ 38 mm Hg group (OR = 5.7, 95% CI: 1.5–22.0), the risk of extubation failure in the ΔIAP 22–37 mm Hg group was 3.8 times that of the ΔIAP ≥ 38 mm Hg group (OR = 3.8, 95% CI: 1.0–15.3). The area under the curve (AUC) predicted by ΔIAP for extubation failure was 0.721, the cutoff value was 31 mm Hg with 82.8% sensitivity and 48.6% specificity. There were no significant differences in the duration of MV, length of ICU stay, and death in ICU of the three groups of patients (all p > 0.05).
Conclusions:
The ΔIAP has good reference value for predicting extubation failure, which is negatively correlated with the risk of extubation failure in patients with MV. For MV patients with ΔIAP ≤ 31 mm Hg, they may have higher risk of extubation failure; early alert and interventions are highlighted for those patients.
Reducing extubation failure is vital to the early recovery of pa- tients with mechanical ventilation (MV). We aimed to explore the predictive value of the change of intra-abdominal pressure (ΔIAP) before extubation for the extubation failure of MV patients.
Material and methods:
failure of MV patients. Material and methods: Patients undergoing MV for more than 24 h were selected. We used a urodynamic monitor to measure ΔIAP 30 min before extubation. The characteristics and prognosis of MV patients were analyzed. A receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of ΔIAP for extubation failure.
Results:
A total of 173 MV patients were included. The risks of extubation failure increased with the decrease of ΔIAP. The risk of extubation failure in the ΔIAP ≤ 21 mm Hg group was 5.7 times that of the ΔIAP ≥ 38 mm Hg group (OR = 5.7, 95% CI: 1.5–22.0), the risk of extubation failure in the ΔIAP 22–37 mm Hg group was 3.8 times that of the ΔIAP ≥ 38 mm Hg group (OR = 3.8, 95% CI: 1.0–15.3). The area under the curve (AUC) predicted by ΔIAP for extubation failure was 0.721, the cutoff value was 31 mm Hg with 82.8% sensitivity and 48.6% specificity. There were no significant differences in the duration of MV, length of ICU stay, and death in ICU of the three groups of patients (all p > 0.05).
Conclusions:
The ΔIAP has good reference value for predicting extubation failure, which is negatively correlated with the risk of extubation failure in patients with MV. For MV patients with ΔIAP ≤ 31 mm Hg, they may have higher risk of extubation failure; early alert and interventions are highlighted for those patients.
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