Risk factors for extubation failure in patients following a successful spontaneous breathing trial

Fernando Frutos-Vivar, Niall D. Ferguson, Andrés Esteban, Scott K. Epstein, Yaseen Arabi, Carlos Apezteguía, Marco González, Nicholas S. Hill, Stefano Nava, Gabriel D'Empaire, Antonio Anzueto

Research output: Contribution to journalArticlepeer-review

264 Scopus citations


Background: To assess the factors associated with reintubation in patients who had successfully passed a spontaneous breathing trial. Methods: We used logistic regression and recursive partitioning analyses of prospectively collected clinical data from adults admitted to ICUs of 37 hospitals in eight countries, who had undergone invasive mechanical ventilation for > 48 h and were deemed ready for extubation. Results: Extubation failure occurred in 121 of the 900 patients (13.4%). The logistic regression analysis identified the following associations with reintabation: rapid shallow breathing index (RSBI) [odds ratio (OR), 1.009 per unit; 95% confidence interval (CI), 1.003 to 1.015]; positive fluid balance (OR, 1.70; 95% CI, 1.15 to 2.53); and pneumonia as the reason for initiating mechanical ventilation (OR, 1.77; 95% CI, 1.10 to 2.84). The recursive partitioning analysis allowed the separation of patients into different risk groups for extubation failure: (1) RSBI of > 57 breaths/L/min and positive fluid balance (OR, 3.0; 95% CI, 1.8 to 4.8); (2) RSBI of < 57 breaths/L/min and pneumonia as reason for mechanical ventilation (OR, 2.0; 95% CI, 1.1 to 3.6); (3) RSBI of > 57 breaths/L/min and negative fluid balance (OR, 1.4; 95% CI, 0.8 to 2.5); and (4) RSBI of < 57 breaths/L/min (OR, 1 [reference value]). Conclusions: Among routinely measured clinical variables, RSBI, positive fluid balance 24 h prior to extubation, and pneumonia at the initiation of ventilation were the best predictors of extubation failure. However, the combined predictive ability of these variables was weak.

Original languageEnglish (US)
Pages (from-to)1664-1671
Number of pages8
Issue number6
StatePublished - Dec 2006
Externally publishedYes


  • Artificial respiration
  • Extubation
  • Predictive index
  • Reintubation
  • Ventilator weaning

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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