Clinical factors associated with extubation failure and post-extubation laryngeal stridor in adult patients on invasive mechanical ventilation

Abstract

Introduction: Orotracheal intubation is a procedure that implies risks such as extubation failure and laryngeal stridor, which increase the risk of morbidity. Objective: To identify factors associated with early extubation failure (≤24 hours) and the development of post-extubation laryngeal stridor in adult patients on invasive mechanical ventilation (IMV). Materials and methods: Case-control study conducted in the intensive care unit (ICU) of a quaternary care hospital in Bogotá, Colombia, between April 2019 and February 2020, in which information was collected prospectively. A total of 180 patients with IMV ≥24 hours and at least ≥1 extubation attempt were included: 30 cases defined as patients with early extubation failure (≤24 hours to extubation), and 150 controls. Differences between cases and controls regarding the variables considered were determined using the Student's t test and the Chi-squared or Fisher's exact tests. In addition, a multivariate analysis (unconditional logistic regression model) was performed to establish the factors associated with extubation failure and post-extubation laryngeal stridor, calculating the odds ratio (OR) and the respective 95% confidence intervals (95%CI). A significance level of p<0.05 was considered. Results: Early extubation failure and laryngeal stridor had a prevalence of 16.66% (n=30) and 3.89% (n=7), respectively. In the multivariate analysis, having a history of intubation (OR=4.27, 95%CI: 1.44-12.66), the presence of active cancer (OR=2.92, 95%CI: 1.08-7.90), and being diagnosed with pneumonia (OR=2.84, 95%CI: 1.15-6.99) were significantly associated with extubation failure, while the duration of IMV (OR=1.53, 95%CI: 1.18-1.99) and history of intubation (OR=37.99, 95%CI: 2.22-650.8) were significantly associated with post-extubation laryngeal stridor. Conclusions: Based on the results reported here, it is suggested to consider factors such as history of intubation, comorbidity with cancer, and diagnosis of pneumonia in the stratification of critically ill patients to increase the likelihood of successful extubation.

Keywords

• Airway Obstruction
• Laryngeal Edema
• Airway Extubation
• Respiration, Artificial