Cargando…

Predictors of Extubation Failure in Neurocritical Patients Identified by a Systematic Review and Meta-Analysis

BACKGROUND: Prediction of extubation failure, particularly in neurocritical patients, is unique and controversial. We conducted a systematic review and meta-analysis to identify the risk factors for extubation failure in these patients. METHODS: A literature search of databases (MEDLINE, EMBASE, the...

Descripción completa

Detalles Bibliográficos
Autores principales: Wang, Shengnan, Zhang, Lili, Huang, Kaibin, Lin, Zhenzhou, Qiao, Weiguang, Pan, Suyue
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259297/
https://www.ncbi.nlm.nih.gov/pubmed/25486091
http://dx.doi.org/10.1371/journal.pone.0112198
_version_ 1782347983575056384
author Wang, Shengnan
Zhang, Lili
Huang, Kaibin
Lin, Zhenzhou
Qiao, Weiguang
Pan, Suyue
author_facet Wang, Shengnan
Zhang, Lili
Huang, Kaibin
Lin, Zhenzhou
Qiao, Weiguang
Pan, Suyue
author_sort Wang, Shengnan
collection PubMed
description BACKGROUND: Prediction of extubation failure, particularly in neurocritical patients, is unique and controversial. We conducted a systematic review and meta-analysis to identify the risk factors for extubation failure in these patients. METHODS: A literature search of databases (MEDLINE, EMBASE, the Cochrane Library, and Web of Science) was performed up to August of 2013 to identify trials that evaluated extubation failure predictors. Included trials were either prospective or retrospective cohort studies. RESULTS: Nine studies involving 928 participants were included. The systematic review and meta-analysis revealed that the following were predictive for extubation failure: pneumonia, atelectasis, mechanical ventilation of >24 h, a low Glasgow Coma Scale score (7–9T) (OR = 4.96, 95% CI = 1.61–15.26, P = 0.005), the inability to follow commands (OR = 2.07, 95% CI = 1.15–3.71, P = 0.02), especially the command to close the eyes, thick secretion, and no intact gag reflex. Meanwhile, the following were not predictive for extubation failure: sex, secretion volume, coughing upon suctioning, and the inability to follow one command among showing two fingers, wiggling the toes, or coughing on command. Additionally, some traditional weaning parameters were shown to poorly predict extubation failure in neurocritical patients. CONCLUSIONS: Besides pneumonia, atelectasis, and the duration of mechanical ventilation, other factors that should be taken into consideration in the prediction of extubation failure when neurocritical patients are weaned from tracheal intubation include neurologic abilities (Glasgow Coma Scale score and following commands), the secretion texture, and the presence of a gag reflex.
format Online
Article
Text
id pubmed-4259297
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-42592972014-12-15 Predictors of Extubation Failure in Neurocritical Patients Identified by a Systematic Review and Meta-Analysis Wang, Shengnan Zhang, Lili Huang, Kaibin Lin, Zhenzhou Qiao, Weiguang Pan, Suyue PLoS One Research Article BACKGROUND: Prediction of extubation failure, particularly in neurocritical patients, is unique and controversial. We conducted a systematic review and meta-analysis to identify the risk factors for extubation failure in these patients. METHODS: A literature search of databases (MEDLINE, EMBASE, the Cochrane Library, and Web of Science) was performed up to August of 2013 to identify trials that evaluated extubation failure predictors. Included trials were either prospective or retrospective cohort studies. RESULTS: Nine studies involving 928 participants were included. The systematic review and meta-analysis revealed that the following were predictive for extubation failure: pneumonia, atelectasis, mechanical ventilation of >24 h, a low Glasgow Coma Scale score (7–9T) (OR = 4.96, 95% CI = 1.61–15.26, P = 0.005), the inability to follow commands (OR = 2.07, 95% CI = 1.15–3.71, P = 0.02), especially the command to close the eyes, thick secretion, and no intact gag reflex. Meanwhile, the following were not predictive for extubation failure: sex, secretion volume, coughing upon suctioning, and the inability to follow one command among showing two fingers, wiggling the toes, or coughing on command. Additionally, some traditional weaning parameters were shown to poorly predict extubation failure in neurocritical patients. CONCLUSIONS: Besides pneumonia, atelectasis, and the duration of mechanical ventilation, other factors that should be taken into consideration in the prediction of extubation failure when neurocritical patients are weaned from tracheal intubation include neurologic abilities (Glasgow Coma Scale score and following commands), the secretion texture, and the presence of a gag reflex. Public Library of Science 2014-12-08 /pmc/articles/PMC4259297/ /pubmed/25486091 http://dx.doi.org/10.1371/journal.pone.0112198 Text en © 2014 Wang et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Wang, Shengnan
Zhang, Lili
Huang, Kaibin
Lin, Zhenzhou
Qiao, Weiguang
Pan, Suyue
Predictors of Extubation Failure in Neurocritical Patients Identified by a Systematic Review and Meta-Analysis
title Predictors of Extubation Failure in Neurocritical Patients Identified by a Systematic Review and Meta-Analysis
title_full Predictors of Extubation Failure in Neurocritical Patients Identified by a Systematic Review and Meta-Analysis
title_fullStr Predictors of Extubation Failure in Neurocritical Patients Identified by a Systematic Review and Meta-Analysis
title_full_unstemmed Predictors of Extubation Failure in Neurocritical Patients Identified by a Systematic Review and Meta-Analysis
title_short Predictors of Extubation Failure in Neurocritical Patients Identified by a Systematic Review and Meta-Analysis
title_sort predictors of extubation failure in neurocritical patients identified by a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259297/
https://www.ncbi.nlm.nih.gov/pubmed/25486091
http://dx.doi.org/10.1371/journal.pone.0112198
work_keys_str_mv AT wangshengnan predictorsofextubationfailureinneurocriticalpatientsidentifiedbyasystematicreviewandmetaanalysis
AT zhanglili predictorsofextubationfailureinneurocriticalpatientsidentifiedbyasystematicreviewandmetaanalysis
AT huangkaibin predictorsofextubationfailureinneurocriticalpatientsidentifiedbyasystematicreviewandmetaanalysis
AT linzhenzhou predictorsofextubationfailureinneurocriticalpatientsidentifiedbyasystematicreviewandmetaanalysis
AT qiaoweiguang predictorsofextubationfailureinneurocriticalpatientsidentifiedbyasystematicreviewandmetaanalysis
AT pansuyue predictorsofextubationfailureinneurocriticalpatientsidentifiedbyasystematicreviewandmetaanalysis