Acute Renal Injury at Mechanical Ventilation Weaning Increases Risk of Tracheal Extubation Failure

Abstract

Background:

Current research seeks to improve the success rate of tracheal extubation, however, little is known about the effects of acute renal injury on the tracheal extubation process. Therefore, the aim of this study is to verify if acute renal injury contributes to the failure of tracheal extubation.

Methods:

A retrospective observational study of electronic medical records was performed. Patients admitted to the intensive care unit, between January 2015 and December 2016, age ≥ 18 y, both genders, requiring invasive mechanical ventilation for a period ≥ 48 h had their electronic records evaluated. Patients who needed to return to invasive mechanical ventilation within 48 h of tracheal extubation were classified as ventilatory weaning failure, otherwise they were classified as ventilatory weaning success. Acute renal injury was assessed by the RIFLE criterion. Patients who had at least 100% increase in serum creatinine during the use of invasive mechanical ventilation were classified as acute renal injury.

Results:

Total of 167 patients were evaluated and failure of weaning from invasive mechanical ventilation was 15.6%. Cretinine clearance and water balance were similar between day before and day of tracheal extubation. Tracheal extubation failure group presented lower creatinine clearance when compared to the success group (42 mL/min vs. 100 mL/min respectively, P=0.01). The water balance was higher in the tracheal extubation failure group compared to the success group (739 mL vs. -189 mL, P=0.01). Patients with acute renal injury are 51% more likely to fail tracheal extubation than patients without acute renal injury (OR=2.7; 95% CI: 1.6-4.7; P=0.01).

Conclusions:

Acute renal injury during weaning from invasive mechanical ventilation contributes to the failure of tracheal extubation.