Respiratory failure in chronic obstructive pulmonary disease after extubation: value of expiratory flow limitation and airway occlusion pressure after 0.1 second (P0.1)

• Published in: Journal of critical care 2008-12, Vol.23 (4), p.577-584
• Main Authors: Vargas, Frédéric, MD, Boyer, Alexandre, MD, Bui, Hoang Nam, MD, Salmi, Louis Rachid, MD, PhD, Guenard, Hervé, MD, Gruson, Didier, MD, PhD, Hilbert, Gilles, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute respiratory failure; Aged; Airway occlusion pressure; COPD; Critical Care; Disease; Extubation failure; Female; Forced Expiratory Volume; Humans; Hyperinflation; Intubation; Intubation, Intratracheal; Male; Mortality; Negative expiratory pressure; Pulmonary Disease, Chronic Obstructive - physiopathology; Respiratory function tests; Respiratory Insufficiency - physiopathology; Respiratory therapy; Ventilation; Ventilator Weaning; Weaning
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2007.12.009

Abstract Purpose The aim of this study was to confirm the ability of the airway occlusion pressure after 0.1 second (P0.1) recorded after extubation to define chronic obstructive pulmonary disease (COPD) patients with a high risk of postextubation respiratory failure and to evaluate the role of the expiratory flow limitation (EFL) in these patients. Materials and Methods Thirty 5 COPD patients who had been weaned from mechanical ventilation and extubated were included in the study. Expiratory flow limitation by the negative expiratory pressure method and P0.1 were recorded at the first hour of postextubation. We determined whether those patients who developed postextubation respiratory failure (failed extubation group) differed from those who did not (successful extubation group). Results Fourteen patients presented a postextubation respiratory failure. Expiratory flow limitation and P0.1 values in the failed extubation group, respectively (61.6% ± 34.0%; 4.3 ± 1.7 cm H2 0) were significantly different ( P < .05) from those observed in the successful extubation group, respectively (20.3% ± 24.6%; 1.8 ± 0.8 cm H2 0). P0.1 and EFL would seem to be of use in predicting extubation outcome, respectively (OR 3.66, 95% confidence interval 1.68-7.94; OR 1.04, 95% confidence interval 1.01-1.07). The area under the receiver operating characteristic curve for diagnosing postextubation respiratory failure was 0.84 for EFL and 0.87 for P0.1. Conclusion Bedside evaluation of EFL and P0.1 helps to define COPD patients at high risk for postextubation respiratory failure. Extubation failure in COPD was associated with higher EFL.