Abstract
Background:
The aim of this study was to investigate the predictors of mortality after planned extubation in the nonagenarian pneumonia patients with acute respiratory failure.
Methods:
A retrospective review from medical records was conducted for the nonagenarian patients with acute respiratory failure. All of these patients were under endotracheal tube intubation with mechanical ventilation support in intensive care units (ICUs) of Chi-Mei Medical Center, Taiwan from 1 Jan 2010 to 31 Dec 2017. Patient characters, such as disease severity (APACHE II, and TISS scores), body mass index (BMI), vital signs, laboratory data were collected. Reintubation was defined as intubation again due to acute respiratory failure after the first planned extubation in the hospital. The stay time in hospital and their medical costs were measured also. Statistical analysis of the data was done by SPSS version 18.0. Logistic regression statistical analysis was done. Statistical significance was set at P ＜ .05.
Results:
114 nonagenarian patients over 24 hours MV support were enrolled in this study. The average age of all patients was 92.5 ± 3.0. The hospital survival rate was 71.1% (81 over 114 cases) of these patients. Compared with the hospital survival cohort, high APACHE II (23.5 VS 21.5), high blood urea nitrogen(BUN) level (42.4 VS 31.4 mg/dL) and low hemoglobin (Hb) before extubation (9.3 vs. 10.3 mg/dL) were found in the hospital death patients. Compared with the hospital deaths cohort, higher rate of beginning weaning over 3days after intubation (29.6% VS 60.6%),lower reintubation rate during hospital (13.6% VS 33.3%) and lower prolonged weaning rate (45.7% VS 66.7%) were found in the hospital survival patients. Moreover, prolonged ICU (17.1 VS. 13.2days) with higher costs of medical care (33.8 vs 27.7 thousands in New Taiwan dollars) were also found in this cohort. The higher reintubation rate during hospital, lower Hb (Hb<10.3 mg/dL) and higher rate of beginning weaning over 3days after intubation,revealed the independent risk factors of hospital mortality (P < .05) for the cohort.
Conclusions:
Reintubation was one of the three independent predictors of mortality in acute respiratory failure after planned extubation in nonagenarian patients with pneumonia. The hospital death patients exhibited a prolonged ICU with higher costs of medical care. Keywords: reintubation, planned extubation, nonagenarian, respiratory failure, pneumonia.
The statistical analysis ways were the logistic regression and ROC statistics analysis. View all access options for this article.The independent predictor factors of mortality in the planned extubation nonagenarian patients received endotracheal intubation
Parameters
odds ratio
95%CI
p value
reintubation during hospital
3.565
1.210-10.504
0.021
Hb<10.3 mg/dL
3.525
1.341-9.262
0.011
beginning weaning over 3days after intubation
4.060
1.613-10.222
0.003
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