AUTHOR=Bansal Vikas , Smischney Nathan J. , Kashyap Rahul , Li Zhuo , Marquez Alberto , Diedrich Daniel A. , Siegel Jason L. , Sen Ayan , Tomlinson Amanda D. , Venegas-Borsellino Carla P. , Freeman William David 

TITLE=Reintubation Summation Calculation: A Predictive Score for Extubation Failure in Critically Ill Patients

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.789440

DOI=10.3389/fmed.2021.789440

ISSN=2296-858X

ABSTRACT=<sec><title>Objective</title><p>To derive and validate a multivariate risk score for the prediction of respiratory failure after extubation.</p></sec><sec><title>Patients and methods</title><p>We performed a retrospective cohort study of adult patients admitted to the intensive care unit from January 1, 2006, to December 31, 2015, who received mechanical ventilation for ≥48 h. Extubation failure was defined as the need for reintubation within 72 h after extubation. Multivariate logistic regression model coefficient estimates generated the <bold>R</bold>e-<bold>I</bold>ntubation <bold>S</bold>ummation <bold>C</bold>alculation (RISC) score.</p></sec><sec><title>Results</title><p>The 6,161 included patients were randomly divided into 2 sets: derivation (<italic>n</italic> = 3,080) and validation (<italic>n</italic> = 3,081). Predictors of extubation failure in the derivation set included body mass index &lt;18.5 kg/m<sup>2</sup> [odds ratio (OR), 1.91; 95% CI, 1.12–3.26; <italic>P</italic> = 0.02], threshold of Glasgow Coma Scale of at least 10 (OR, 1.68; 95% CI, 1.31–2.16; <italic>P</italic> &lt; 0.001), mean airway pressure at 1 min of spontaneous breathing trial &lt;10 cmH<sub>2</sub>O (OR, 2.11; 95% CI, 1.68–2.66; <italic>P</italic> &lt; 0.001), fluid balance ≥1,500 mL 24 h preceding extubation (OR, 2.36; 95% CI, 1.87–2.96; <italic>P</italic> &lt; 0.001), and total mechanical ventilation days ≥5 (OR, 3.94; 95% CI 3.04–5.11; <italic>P</italic> &lt; 0.001). The C-index for the derivation and validation sets were 0.72 (95% CI, 0.70–0.75) and 0.72 (95% CI, 0.69–0.75). Multivariate logistic regression demonstrated that an increase of 1 in RISC score increased odds of extubation failure 1.6-fold (OR, 1.58; 95% CI, 1.47–1.69; <italic>P</italic> &lt; 0.001).</p></sec><sec><title>Conclusion</title><p>RISC predicts extubation failure in mechanically ventilated patients in the intensive care unit using several clinically relevant variables available in the electronic medical record but requires a larger validation cohort before widespread clinical implementation.</p></sec>