Incidence, Risk Factors, and Long-Term Outcomes for Extubation Failure in ICU in Patients With Obesity: A Retrospective Analysis of a Multicenter Prospective Observational Study.

IF 9.5 1区医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2024-09-07 DOI:10.1016/j.chest.2024.07.171

Audrey De Jong, Mathieu Capdevila, Yassir Aarab, Matthieu Cros, Joris Pensier, Ines Lakbar, Clément Monet, 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, Nicolas Molinari, Gerald Chanques, Laurent Papazian, Elie Azoulay, Samir Jaber

{"title":"Incidence, Risk Factors, and Long-Term Outcomes for Extubation Failure in ICU in Patients With Obesity: A Retrospective Analysis of a Multicenter Prospective Observational Study.","authors":"Audrey De Jong, Mathieu Capdevila, Yassir Aarab, Matthieu Cros, Joris Pensier, Ines Lakbar, Clément Monet, 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, Nicolas Molinari, Gerald Chanques, Laurent Papazian, Elie Azoulay, Samir Jaber","doi":"10.1016/j.chest.2024.07.171","DOIUrl":null,"url":null,"abstract":"Background: To our knowledge, no large observational study has compared the incidence and risk factors for extubation failure within 48 h and during ICU stay in the same cohort of unselected critically ill patients with and without obesity.Research question: Which are the incidence and risk factors of extubation failure in patients with and without obesity?Study design and methods: In this prospective multicenter observational FREE-REA study in 26 ICUs, the primary objective was to compare the incidence of extubation failure within 48 h in patients with and without obesity. Secondary objectives were to describe and to identify the independent specific risk factors for extubation failure, using first a logistic regression model and second a decision tree analysis.Results: Of 1,370 extubation procedures analyzed, 288 (21%) were performed in patients with obesity and 1,082 (79%) in patients without obesity. The incidence of extubation failure within 48 h among patients with or without obesity was 23 of 288 (8.0%) vs 118 of 1,082 (11%), respectively (unadjusted OR, 0.71; 95% CI, 0.45-1.13; P = .15); alongside patients with obesity receiving significantly more noninvasive ventilation [87 of 288 (30%) vs 233 of 1,082 (22%); P = .002] and physiotherapy [165 of 288 (57%) vs 527 of 1,082 (49%); P = .02] than patients without obesity. Risk factors for extubation failure also differed according to obesity status: female sex (adjusted OR, 4.88; 95% CI, 1.61-13.9; P = .002) and agitation before extubation (adjusted OR, 6.39; 95% CI, 1.91-19.8; P = .001) in patients with obesity, and absence of strong cough before extubation (adjusted OR, 2.38; 95% CI, 1.53-3.84; P = .0002) and duration of invasive mechanical ventilation before extubation (adjusted OR, 1.03/d; 95% CI, 1.01-1.06; P = .01) in patients without obesity. The decision tree analysis found similar risk factors.Interpretation: Our findings indicate that anticipation and application of preventive measures for patients with obesity before and after extubation led to similar rate of extubation failure among patients with and without obesity.Clinical trial registration: ClinicalTrials.gov; No.: NCT02450669; URL: www.Clinicaltrials: gov.","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5000,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chest","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.chest.2024.07.171","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background: To our knowledge, no large observational study has compared the incidence and risk factors for extubation failure within 48 h and during ICU stay in the same cohort of unselected critically ill patients with and without obesity.

Research question: Which are the incidence and risk factors of extubation failure in patients with and without obesity?

Study design and methods: In this prospective multicenter observational FREE-REA study in 26 ICUs, the primary objective was to compare the incidence of extubation failure within 48 h in patients with and without obesity. Secondary objectives were to describe and to identify the independent specific risk factors for extubation failure, using first a logistic regression model and second a decision tree analysis.

Results: Of 1,370 extubation procedures analyzed, 288 (21%) were performed in patients with obesity and 1,082 (79%) in patients without obesity. The incidence of extubation failure within 48 h among patients with or without obesity was 23 of 288 (8.0%) vs 118 of 1,082 (11%), respectively (unadjusted OR, 0.71; 95% CI, 0.45-1.13; P = .15); alongside patients with obesity receiving significantly more noninvasive ventilation [87 of 288 (30%) vs 233 of 1,082 (22%); P = .002] and physiotherapy [165 of 288 (57%) vs 527 of 1,082 (49%); P = .02] than patients without obesity. Risk factors for extubation failure also differed according to obesity status: female sex (adjusted OR, 4.88; 95% CI, 1.61-13.9; P = .002) and agitation before extubation (adjusted OR, 6.39; 95% CI, 1.91-19.8; P = .001) in patients with obesity, and absence of strong cough before extubation (adjusted OR, 2.38; 95% CI, 1.53-3.84; P = .0002) and duration of invasive mechanical ventilation before extubation (adjusted OR, 1.03/d; 95% CI, 1.01-1.06; P = .01) in patients without obesity. The decision tree analysis found similar risk factors.

Interpretation: Our findings indicate that anticipation and application of preventive measures for patients with obesity before and after extubation led to similar rate of extubation failure among patients with and without obesity.

Clinical trial registration: ClinicalTrials.gov; No.: NCT02450669; URL: www.

Clinicaltrials: gov.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

肥胖症患者在重症监护室拔管失败的发生率、风险因素和长期疗效一项多中心前瞻性观察研究的回顾性分析。

背景：还没有一项大型观察性研究比较过同一队列未经筛选的肥胖和非肥胖重症患者在48小时内和重症监护室（ICU）住院期间拔管失败的发生率和风险因素：研究问题：肥胖和非肥胖患者拔管失败的发生率和风险因素是什么？这项前瞻性多中心FREE-REA观察性研究在26个重症监护病房进行，主要目的是比较肥胖和非肥胖患者48小时内拔管失败的发生率。次要目标是利用逻辑回归模型和决策树分析法描述和识别导致拔管失败的独立特定风险因素：在分析的1370例拔管手术中，288例（21%）由肥胖症患者实施，1082例（79%）由非肥胖症患者实施。有无肥胖症患者在 48 小时内拔管失败的发生率分别为 23/288（8.0%）对 118/1082（11%）；未调整的几率比（OR）为 0.71 95% 置信区间（CI，0.45-1.13），P=0.15）。此外，肥胖患者接受无创通气（87/288，30% 对 233/1082，22%，P=0.002）和理疗（165/288，57% 对 527/1082，49%，P=0.02）的比例明显高于非肥胖患者。拔管失败的风险因素也因肥胖状态而异：女性[调整后（a）OR 4.88 95%CI (1.61-13.9)，P=0.002]和拔管前躁动[aOR 6.39 95%CI (1.91-19.8)，P=0.001]；在无肥胖症患者中，拔管前无强烈咳嗽[aOR 2.38 95%CI (1.53-3.84)，P=0.0002]和拔管前有创机械通气持续时间[aOR 1.03 每天 95%CI (1.01-1.06)，P=0.01]。决策树分析也发现了类似的风险因素：我们的研究结果表明，在拔管前后对肥胖症患者进行预测并采取预防措施，会导致肥胖症患者和非肥胖症患者的拔管失败率相似：NCT XXX.

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.