The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Pei-Ya Li1, Tsung-Ming Yang1,2, Tien-Pei Fang1, Shu-Huai Cheng1; 1Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; 2Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan

Background: Postextubation respiratory failure is a major complication in patients received prolonged mechanical ventilation (PMV) and is associated with higher complication rate, longer ventilator days, longer ICU and hospital stay, and increased hospital mortality. Previous studies showed that larger neck circumference (NC) increased the risk of upper airway obstruction. In addition, obesity and increased waist circumference (WC) were also found to be associated with respiratory failure. In this study, we investigate whether obesity, neck and waist circumference increased the risk of postextubation respiratory failure or not in patients received prolonged mechanical ventilation. Methods: Patient who were mechanically ventilated for more than 21 days were referred to regional weaning center after their clinical condition were stabilized and were ready to wean from mechanical ventilation. Among these PMV patients, those who were not tracheostomized and were extubated following a successful spontaneous trial were enrolled in this study. The gender, age, intubation date, Glasgow coma scale, APACHE II, and ICU stay were recorded. The BMI, neck circumference, waist circumference, and weaning indices were measured upon arrival to the weaning center. The cuff leak percentage was measured within 3 days before extubation. The outcome of extubation and the BMI, the neck and waist circumference were compared. Results: A total of 55 patients were enrolled in this study. Patients were categorized into 2 groups. The first group consisted of 15 patients with larger NC (^ 43 cm) and larger WC (^ 90 cm). The second group consisted of 40 patients with smaller NC (< 43 cm) and/or smaller WC (< 90 cm). There was no significant difference in gender, age, APACHE II score, coma scale, weaning indices, and cuff leak between these two groups. Patients with larger NC and larger WC had higher rate of postextubation respiratory failure (53% vs. 23%, odds ratio: 3.937), lower hospital weaning rate (40% vs. 72.5%), and higher ventilator dependent rate (33% vs. 10%). Conclusion: In this study, we found that larger NC plus larger WC were associated with increased risk of postextubation respiratory failure, lower hospital weaning rate and higher ventilator dependent rate in PMV patients. Further study is needed to reduce the risk of post-extubation respiratory failure in PMV patients with larger NC plus larger WC. Sponsored Research - None Neck circumference (NC), waist circumference (WC), and postextubation respiratory failure