Incidence and factors associated with failed planned extubation at Moi Teaching and Referral Hospital Intensive Care Unit, Eldoret

Abstract

Background: Failed extubation is associated with increased morbidity and mortality. In addition to acute airway complications, re-intubated patients have higher mortality rates, prolonged hospital length of stay and higher costs. Despite planning, up to 25 % of patients fail extubation within 72 hours. Optimizing weaning using protocols reduces incidence of failed planned extubation when compared with standard physician-directed approach utilized at Moi teaching and referral hospital (MTRH). While the factors associated with extubation failure are modifiable, its burden at MTRH remains unknown. Objective: To establish the incidence proportion and describe factors associated with failed planned extubation at MTRH Intensive care unit (ICU) Methods: This was a prospective observational study done at MTRH ICU. A total of 104 patients who had undergone planned extubation were enrolled through systematic sampling between March 2019 and February 2020. Once eligible patients were extubated their biodata, intubation, mechanical ventilation and extubation details were collected using interviewer administered structured questionnaire and those requiring re-intubation within 72 hours were considered to have failed extubation. Data analysis: Continuous data was summarized as median and categorical data as frequencies and proportions. Fisher‟s Exact Test was used to assess associations between categorical variables and non-parametric Kruskal-Wallis Test was used for continuous independent variables. A p-value < 0.05 was considered statistically significant. Results: About half of the participants had been admitted postoperatively and majority were neurosurgical patients. Fifty eight percent were male and the median age was 38 years. The median age for participants who had failed extubation was 66 compared to 32 years for those extubated successfully. The median severity of illness on admission measured using the Simplified Acute Physiological Score II (SAPS II) among patients who had failed extubation was 50 compared with 17 for those extubated successfully. Thirty two percent of all the participants had comorbidities and among this group, 76% had failed extubation. The Duration of ventilation was longer with a median of 10 days for those who failed compared to 4 days for those who were successfully extubated. Eighteen percent of the participants had an Arterial partial pressures of Oxygen/Fraction of inspired oxygen (PaO2/ FiO2) ratio <100 prior to extubation and among them 90% failed extubation. Four out of ten (39%) of all the participants had failed extubation. The factors statistically significantly associated with failed planned extubation were prolonged mechanical ventilation and a PaO2/ FiO2 ratio <100 prior to extubation. Conclusions: Incidence proportion of failed planned extubation was 39%, a figure higher than global average. The most significant factors associated with failed planned extubation were prolonged ventilation and a PaO2/ FiO2 ratio <100 prior to extubation. Recommendations: There is need to develop and implement standardized weaning protocols at MTRH to optimize patients‟ readiness for extubation.