Standard spontaneous breathing trial parameters may not predict unplanned reintubation for trauma patients

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-01-26 DOI:10.1016/j.amjsurg.2025.116224

Caroline Given , Melissa Chang , Natassia Dunn , Areg Grigorian , Claudia Alvarez , Sigrid Burruss , Theresa Chin , Catherine Kuza , Jeffry Nahmias

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引用次数: 0

Abstract

Background

The applicability of spontaneous breathing trial (SBT) factors such as negative inspiratory force (NIF) and rapid shallow breathing index (RSBI) as predictors of reintubation in trauma patients (TPs) is unclear. This study aimed to identify predictors of unplanned reintubation (UR) in TPs.

Methods

A single center, retrospective (1/2017–12/2023) study of TPs ≥18 years-old extubated from endotracheal mechanical ventilation was performed. Patients with UR during admission were compared to patients without UR. A multivariable logistic regression was performed to identify risk factors associated with UR.

Results

39 of 424 TPs (9.2 %) had UR. UR patients were older (median: 55 vs 39 years-old, p = 0.012) and more often had congestive heart failure (10.3 % vs 1.6 %, p < 0.001), cirrhosis (7.7 % vs 1.9 %, p = 0.025), end stage renal disease (7.7 % vs 1.6 %, p = 0.044), and a higher injury severity scores (ISS) (median: 27 vs 18, p < 0.001). UR patients had increased ventilator days (median: 6 vs 2, p < 0.001) prior to extubation, whereas RSBI and NIF were similar (median: 36 vs 32, p = 0.508) and (median: −24.0 vs −27.0 cm H₂O, p = 0.190). On multivariable analysis, RSBI <50 or <105 and NIF < -20 were not associated with UR. Age (OR 1.03, CI 1.01–1.05, p = 0.006) and ISS (OR 1.04, CI 1.01–1.08, p = 0.022) were independently associated with increased risk of UR.

Conclusions

SBT parameters (RSBI and NIF) were not associated with UR. Age and ISS were independently associated with UR. This suggests additional patient-specific factors should help guide extubation decisions for TPs.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.