Abstract:
Objective: To assess whether there
is an association between 48-hour
postextubation fluid balance and
extubation failure.
Methods: This was a prospective
cohort study that included patients
admitted to the intensive care unit of
a tertiary hospital in southern Brazil
from March 2019 to December 2019.
Patients who required mechanical
ventilation for at least 24 hours and
who were extubated during the study
period were included. The primary
outcome was extubation failure,
considered as the need for reintubation
in the first 72 hours after extubation.
The secondary outcome was a combined
outcome with extubation failure or
the need for therapeutic noninvasive
ventilation.
Results: A total of 101 patients
were included. Extubation failure was
observed in 29 (28.7%) patients. In
univariate analysis, patients with a
negative 48-hour postextubation fluid balance higher than one liter had a
lower rate of extubation failure (12.0%)
than patients with a negative 48-hour
postextubation fluid balance lower than
1L (34.2%; p = 0.033). Mechanical
ventilation duration and negative 48-
hour postextubation fluid balance
lower than one liter were associated
with extubation failure when corrected
for Simplified Acute Physiology Score
3 in multivariate analysis. When we
evaluated the combined outcome, only
negative 48-hour postextubation lower
than 1L maintained an association
when corrected for for Simplified Acute
Physiology Score 3 and mechanical
ventilation duration.
Conclusion: The 48-hour
postextubation fluid balance is associated
with extubation failure. Further studies
are necessary to assess whether avoiding
positive fluid balance in this period
might improve weaning outcomes.
