Clinical Predictors of Extubation Failure in Postoperative Critically Ill Patients: a Post-hoc Analysis of a Multicenter Prospective Observational Study

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2025 Mar 16

PMID 40089666

Authors

Jun Hattori

Aiko Tanaka

Junko Kosaka

Osamu Hirao

Nana Furushima

Yuichi Maki

Daijiro Kabata

Akinori Uchiyama

Moritoki Egi

Hiroshi Morimatsu

Satoshi Mizobuchi

Yoshifumi Kotake

Ayumi Shintani

Yukiko Koyama

Takeshi Yoshida

Yuji Fujino

Affiliations

Soon will be listed here.

Abstract

Background: Postoperative patients constitute majority of critically ill patients, although factors predicting extubation failure in this group of patients remain unidentified. Aiming to propose clinical predictors of reintubation in postoperative patients, we conducted a post-hoc analysis of a multicenter prospective observational study.

Methods: This study included postoperative critically ill patients who underwent mechanical ventilation for > 24 h and were extubated after a successful 30-min spontaneous breathing trial. The primary outcome was reintubation within 48 h after extubation, and clinical predictors for reintubation were investigated using logistic regression analyses.

Results: Among the 355 included patients, 10.7% required reintubation. Multivariable logistic regression identified that the number of endotracheal suctioning episodes during the 24 h before extubation and underlying respiratory disease or pneumonia occurrence were significantly associated with reintubation (adjusted odds ratio [OR] 1.11, 95% confidence interval [CI] 1.05-1.18, p < 0.001; adjusted OR 2.58, 95%CI 1.30-5.13, p = 0.007). The probability of reintubation was increased significantly with the higher frequency of endotracheal suctioning, as indicated by restricted cubic splines. Subgroup analysis showed that these predictors were consistently associated with reintubation regardless of the use of noninvasive respiratory support after extubation.

Conclusions: Endotracheal suctioning frequency and respiratory complications were identified as independent predictors of reintubation. These readily obtainable predictors may aid in decision-making regarding the extubation of postoperative patients.

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