Khamiees et al identified factors associated with successful extubation in patients who have undergone a successful spontaneous breathing trial after mechanical ventilation. This can help identify a patient who may require closer monitoring following extubation. The authors are from Bridgeport Hospital and Yale University School of Medicine.
Patient selection: intubated patient who has had a successful spontaneous breathing test
Successful extubation: not requiring reintubation during the 72 hours after extubation
Parameters:
(1) cough strength
(2) amount of secretions
(3) hemoglobin
Cough Strength
Grade
no cough on command
0
audible movement of air through the endotracheal tube but no audible cough
1
barely audible cough
2
clearly audible cough
3
stronger cough
4
multiple sequential strong coughs
5
The amount of secretions were graded as:
(1) none
(2) mild
(3) moderate
(4) abundant
Parameter
Finding
Points
cough strength
moderate to strong (Grade 3 to 5)
0
weak (Grade 0 to 2)
1
amount of secretions
no or mild
0
moderate to abundant
1
hemoglobin
> 10 g/dL
0
<= 10 g/dL
1
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the more likely extubation will fail.
• Cough strength and amount of secretions act synergistically on likelihood of extubation failure.
The authors found that patients with a PaO2 to FIO2 ratio of 120 to 200 on mechanical ventilation had a similar rate of successful extubation as patients with the ratio > 200.
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