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Minute Ventilation Recovery Time Measured Using a New, Simplified Methodology Predicts Extubation Outcome

Department of Medicine, Hospital of the Universeity of Pennsylvania, Philadelphia

Scott Halpern, MD, PhD

Department of Medicine, Hospital of the Universeity of Pennsylvania, Philadelphia

Jason D. Christie, MD, MS

Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia

Robert Gallop, PhD

Medical Intensive Care Unit and Respiratory Care Services, Hospital of the University of Pennsylvania, Philadelphia

Barry D. Fuchs, MD

Department of Mathematics, Applied Statistics Program, West Chester University of Pennsylvania, West Chester, barry.fuchs{at}uphs.upenn.edu

Extubation failure is associated with poor intensive care unit and hospital outcomes. Minute ventilation recovery time, an integrative measure of a patient's respiratory reserve, has been shown in a pilot study to predict extubation outcome; however, the methodology is subjective and impractical for routine use. The authors hypothesize that minute ventilation recovery time, measured using an objective and simpler method, would predict extubation outcome. A prospective cohort study was performed in adult medical and surgical intensive care unit patients intubated for >24 hours who were weaning from mechanical ventilation. Minute ventilation recovery time was measured using a new, simplified, and objective method following the final spontaneous breathing trial prior to extubation. The primary outcome was extubation failure, defined as reintubation within 7 days. The study cohort comprised 88 patients, of whom 22 (25%) failed extubation after a median of 3 days. Demographic data, weaning parameters, and the proportion of patients who passed an extubation screen were similar between groups (P > .05). Minute ventilation recovery time was significantly longer in patients who failed extubation (15 [5-15] vs 2 [1-5] minutes, P < .001), consistent in both medical and surgical subgroups. Operating characteristics for a preliminary threshold (minute ventilation recovery time 5 minutes) for prediction of extubation failure were sensitivity = 0.78, specificity = 0.71, positive predictive value = 0.47, negative predictive value = 0.90, correctly classified = 0.72. Adjustment for significant covariates did not alter the relationship between minute ventilation recovery time 5 minutes and extubation failure (odds ratio = 4.9, 95% confidence interval 1.45-16.2, P < .02). C statistic was 0.79 ± 0.17. It was concluded that minute ventilation recovery time, measured using a feasible methodology, can predict extubation outcome in medical and surgical intensive care unit patients.

Key Words: weaning • mechanical • ventilation • extubation failure

Journal of Intensive Care Medicine, Vol. 23, No. 1, 52-60 (2008)
DOI: 10.1177/0885066607310302


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