Renal Function Markers Predicts Extubation Failure in Critically Ill Patients: A Retrospective Study.

Abstract

Several studies attempt to identify predictors for weaning and extubation from mechanical ventilation (MV) and none have been shown to be particularly accurate. Therefore, the objective of the study was to evaluate whether markers of renal function may be associated with extubation failure. This retrospective study collected data through electronic medical records for 2 consecutive years. The inclusion criteria were: ≥18 years old and requiring invasive MV for a period of ≥48 hours. Extubation failure was determined when subjects needed to return to invasive MV within 48 hours of the tracheal tube withdrawal. Acute kidney injury (AKI) was assessed according to the KDIGO classification. From a total of 167 subjects, 15% evolved with extubation failure. Lower creatinine clearance and higher fluid balance was observed in the extubation failure group compared to the successful extubation group (42 mL/min vs 100 mL/min, P = 0.01 and 739 mL vs - 189 mL, P = 0.01, respectively). Subjects with AKI are 51% more likely to evolve with extubation failures than those with normal renal function (OR = 2.7; 95% CI: 1.6-4.7; P < 0.01). Renal dysfunction was related to the rate of extubation failure. Fluid balance and serum creatinine may be aspects to be considered when making the extubation decision.