Factor Influencing Successful Liberation of Endotracheal Tube in Surgical Intensive Care Unit

Abstract

Objective: To determine the successful rate of extubation in surgical intensive care unit (ICU) patients who had retained endotracheal tube for more than 24 hours, after spontaneous breathing trial was established and extubation protocol was followed by attended surgical ICU nurse.

Method: All patients who was admitted to surgical ICU between January 2009 and July 2010 were prospectively followed. The baseline characteristics were assessed and recorded if minimal criteria for extubation was met. Spontaneous breathing trial (SBT) was performed per protocol. The respiratory data was collected immediately before initiation of SBT, at 2 minutes and at 60 minutes after SBT.

Result: Ninety seven patients who were intubated in surgical ICU were recruited in this study. After established SBT, 86 patients (88%) succeeded extubation. Eleven patients (11%) failed extubation. Four of them required reintubation within 24 hours. There were significant difference in means of tidal volumes, respiratory rates, rapid shallow breathing indices (RSBI), and peak inspiratory pressures at 60 minutes after SBT between patients who had successful extubation and those who had failed. The area under curve of ROC for RSBI at 60 minutes after SBT yielded the highest accuracy among other factors (87%)

Conclusion: SBT was safe and had high yield of successful extubation in surgical patients. However, closed respiratory monitor accompanied with respiratory parameter monitoring during SBT was necessary.