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Establishing failure predictors for the planned extubation of overweight and obese patients.

Establishing failure predictors for the planned extubation of overweight and obese patients.
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Chao CM, Lai CC, Cheng AC, Chiang SR, Liu WL, Ho CH, Hsing SC, Chen CM, Cheng KC,


Chao CM, Lai CC, Cheng AC, Chiang SR, Liu WL, Ho CH, Hsing SC, Chen CM, Cheng KC, (click to view)

Chao CM, Lai CC, Cheng AC, Chiang SR, Liu WL, Ho CH, Hsing SC, Chen CM, Cheng KC,

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PloS one 2017 08 1612(8) e0183360 doi 10.1371/journal.pone.0183360
Abstract

We investigated failure predictors for the planned extubation of overweight (body mass index [BMI] = 25.0-29.9) and obese (BMI ≥ 30) patients. All patients admitted to the adult intensive care unit (ICU) of a tertiary hospital in Taiwan were identified. They had all undergone endotracheal intubation for > 48 h and were candidates for extubation. During the study, 595 patients (overweight = 458 [77%]); obese = 137 [23%]) with planned extubation after weaning were included in the analysis; extubation failed in 34 patients (5.7%). Their mean BMI was 28.5 ± 3.8. Only BMI and age were significantly different between overweight and obese patients. The mortality rate for ICU patients was 0.8%, and 2.9% for inpatients during days 1-28; the overall in-hospital mortality rate was 8.4%. Failed Extubation group patients were significantly older, had more end-stage renal disease (ESRD), more cardiovascular system-related respiratory failure, higher maximal inspiratory pressure (MIP), lower maximal expiratory pressure (MEP), higher blood urea nitrogen, and higher ICU- and 28-day mortality rates than did the Successful Extubation group. Multivariate logistic regression showed that cardiovascular-related respiratory failure (odds ratio [OR]: 2.60; 95% [confidence interval] CI: 1.16-5.80), ESRD (OR: 14.00; 95% CI: 6.25-31.35), and MIP levels (OR: 0.94; 95% CI: 0.90-0.97) were associated with extubation failure. We conclude that the extubation failure risk in overweight and obese patients was associated with cardiovascular system-related respiratory failure, ESRD, and low MIP levels.

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