Independent Risk Factors of Failed Extubation among Adult Critically Ill Patients: A Prospective Observational Study from Saudi Arabia.

Background: Mechanical ventilation provides essential support for critically ill patients in several diagnoses; however, extubation failure can affect patient outcomes. From Saudi Arabia, no study has assessed the factors associated with extubation failure in adults.

Methods: This prospective observational study was conducted in the intensive care unit of a tertiary care hospital in Riyadh, Saudi Arabia. Adult patients who had been mechanically ventilated via the endotracheal tube for a minimum of 24 hours and then extubated according to the weaning protocol were included. Failed extubation was defined as reintubation within 48 hours of extubation.

Results: A total of 505 patients were included, of which 72 patients had failed extubation (14.3%, 95% CI: 11.4%-17.7%). Compared with the failed extubation group, the successfully extubated group had significantly shorter duration of mechanical ventilation (mean difference: -2.6 days, 95% CI: -4.3 to -1; = 0.001), a slower respiratory rate at the time of extubation (mean difference: -2.3 breath/min, 95% CI: -3.8 to -1; = 0.0005), higher pH (mean difference: 0.02, 95% CI: 0.001-0.04; = 0.03), and more patients with strong cough (percent difference: 17.7%, 95% CI: 4.8%-30.5%; = 0.02). Independent risk factors of failed extubation were age (aOR = 1.02; 95% CI: 1.002-1.03; = 0.03), respiratory rate (aOR = 1.06, 95% CI: 1.01-1.1; = 0.008), duration of mechanical ventilation (aOR = 1.08, 95% CI: 1.03 - 1.1; < 0.001), and pH (aOR = 0.02, 95% CI: 0.0006-0.5; = 0.02).

Conclusion: Older age, longer duration of mechanical ventilation, faster respiratory rate, and lower pH were found to be independent risk factors that significantly increased the odds of extubation failure among adults.