Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures
Samir Jaber,
Hervé Quintard,
Raphael Cinotti,
Karim Asehnoune,
Jean-Michel Arnal,
Christophe Guitton,
Catherine Paugam-Burtz,
Paer Abback,
Armand Mekontso Dessap,
Karim Lakhal,
Sigismond Lasocki,
Gaetan Plantefeve,
Bernard Claud,
Julien Pottecher,
Philippe Corne,
Carole Ichai,
Zied Hajjej,
Nicolas Molinari,
Gerald Chanques,
Laurent Papazian,
Elie Azoulay,
Audrey De Jong
Affiliations
Samir Jaber
PhyMedExp, University of Montpellier, Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier
Hervé Quintard
Université Cote d’Azur, CNRS U7275, CHU de Nice, Service réanimation polyvalente et U 7275, IPMC
Raphael Cinotti
Intensive Care & Anesthesiology Department, University of Nantes, Hotel-Dieu Hospital
Karim Asehnoune
Intensive Care & Anesthesiology Department, University of Nantes, Hotel-Dieu Hospital
Jean-Michel Arnal
Intensive Care Department, Sainte Musse Hospital
Christophe Guitton
Medical Intensive Care Unit, Hôtel-Dieu Teaching Hospital
Catherine Paugam-Burtz
Intensive Care & Anesthesiology Department, Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Beaujon
Paer Abback
Intensive Care & Anesthesiology Department, Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Beaujon
Armand Mekontso Dessap
Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil
Karim Lakhal
Intensive Care & Anesthesiology Department, University of Nantes, Laennec Nord Hospital
Sigismond Lasocki
Département Anesthésie Réanimation, CHU Angers
Gaetan Plantefeve
Medical-Surgical Intensive Care Unit, General Hospital Centre
Bernard Claud
Medical-Surgical Intensive Care Unit, General Hospital Centre
Julien Pottecher
Hôpitaux Universitaires de Strasbourg, Pôle Anesthésie Réanimation Chirurgicale SAMU, Hôpital de Hautepierre, Service d’Anesthésie-Réanimation Chirurgicale, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Institut de Physiologie, Equipe d’Accueil EA3072 “Mitochondrie, stress oxydant et protection musculaire”
Philippe Corne
Medical Intensive Care Unit, Montpellier University Hospital
Carole Ichai
Université Cote d’Azur, CNRS U7275, CHU de Nice, Service réanimation polyvalente et U 7275, IPMC
Zied Hajjej
Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier
Nicolas Molinari
IMAG, CNRS, Univ Montpellier, CHU Montpellier
Gerald Chanques
PhyMedExp, University of Montpellier, Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier
Laurent Papazian
APHM, URMITE UMR CNRS 7278, Hôpital Nord, Réanimation des Détresses Respiratoires et Infections Sévères, Aix-Marseille Univ
Elie Azoulay
Medical Intensive Care Unit, University of Paris-Diderot, Saint Louis Hospital
Audrey De Jong
PhyMedExp, University of Montpellier, Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier
Abstract Background Patients liberated from invasive mechanical ventilation are at risk of extubation failure, including inability to breathe without a tracheal tube (airway failure) or without mechanical ventilation (non-airway failure). We sought to identify respective risk factors for airway failure and non-airway failure following extubation. Methods The primary endpoint of this prospective, observational, multicenter study in 26 intensive care units was extubation failure, defined as need for reintubation within 48 h following extubation. A multinomial logistic regression model was used to identify risk factors for airway failure and non-airway failure. Results Between 1 December 2013 and 1 May 2015, 1514 patients undergoing extubation were enrolled. The extubation-failure rate was 10.4% (157/1514), including 70/157 (45%) airway failures, 78/157 (50%) non-airway failures, and 9/157 (5%) mixed airway and non-airway failures. By multivariable analysis, risk factors for extubation failure were either common to airway failure and non-airway failure: intubation for coma (OR 4.979 (2.797–8.864), P 8 days (OR 1.956 (1.087–3.518), P = 0.025), copious secretions (OR 4.066 (2.268–7.292), P < 0.0001) were specific to airway failure, whereas non-obese status (OR 2.153 (1.052–4.408), P = 0.036) and sequential organ failure assessment (SOFA) score ≥ 8 (OR 1.848 (1.100–3.105), P = 0.02) were specific to non-airway failure. Both airway failure and non-airway failure were associated with ICU mortality (20% and 22%, respectively, as compared to 6% in patients with extubation success, P < 0.0001). Conclusions Specific risk factors have been identified, allowing us to distinguish between risk of airway failure and non-airway failure. The two conditions will be managed differently, both for prevention and curative strategies. Trial registration ClinicalTrials.gov, NCT 02450669. Registered on 21 May 2015.
