Incidence and Risk Model Development for Severe Tachypnea Following Terminal Extubation.

Abstract

BACKGROUND:

Palliative ventilator withdrawal (PVW) in the ICU is a common occurrence.

RESEARCH QUESTION:

The goal of this study was to measure the rate of severe tachypnea as a proxy for dyspnea and to identify characteristics associated with episodes of tachypnea.

STUDY DESIGN AND METHODS:

This study assessed a retrospective cohort of ICU patients from 2008 to 2012 mechanically ventilated at a single academic medical center who underwent PVW. The primary outcome of at least one episode of severe tachypnea (respiratory rate > 30 breaths/min) within 6 h after PVW was measured by using detailed physiologic and medical record data. Multivariable logistic regression was used to examine the association between patient and treatment characteristics with the occurrence of a severe episode of tachypnea post extubation.

RESULTS:

Among 822 patients undergoing PVW, 19% and 30% had an episode of severe tachypnea during the 1-h and 6-h postextubation period, respectively. Within 1 h postextubation, patients with the following characteristics were more likely to experience tachypnea: no pre-extubation opiates (adjusted OR [aOR], 2.08; 95% CI, 1.03-4.19), lung injury (aOR, 3.33; 95% CI, 2.19-5.04), Glasgow Coma Scale score > 8 (aOR, 2.21; 95% CI, 1.30-3.77), and no postextubation opiates (aOR, 1.90; 95% CI, 1.19-3.00).

INTERPRETATION:

Up to one-third of ICU patients undergoing PVW experience severe tachypnea. Administration of pre-extubation opiates (anticipatory dosing) represents a key modifiable factor that may reduce poor symptom control.

• Authors: Corey R Fehnel, Miguel Armengol de la Hoz, Leo A Celi, Margaret L Campbell, Khalid Hanafy, Ala Nozari, Douglas B White, Susan L Mitchell
• Journal: Chest (Chest) Vol. 158 Issue 4 Pg. 1456-1463 (10 2020) ISSN: 1931-3543 [Electronic] United States
• PMID: 32360728 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2020 American College of Chest Physicians. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Airway Extubation (adverse effects)
• Cohort Studies
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Models, Statistical
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Tachypnea (epidemiology, etiology)
• Young Adult