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Central venous saturation is a predictor of reintubation in difficult-to-wean patients*

Teixeira, Cassiano MD; da Silva, Nilton Brandão PhD; Savi, Augusto RPT; Vieira, Silvia Regina Rios PhD; Nasi, Luis Antônio MD; Friedman, Gilberto PhD; Oliveira, Roselaine Pinheiro MD; Cremonese, Ricardo Viegas MD; Tonietto, Túlio Frederico MD; Bressel, Mathias Azevedo Bastian MSc; Maccari, Juçara Gasparetto MD; Wickert, Ricardo RPT; Borges, Luis Guilherme RPT

doi: 10.1097/CCM.0b013e3181bc81ec
Clinical Investigations

Objective: To evaluate the predictive value of central venous saturation to detect extubation failure in difficult-to-wean patients.

Design: Cohort, multicentric, clinical study.

Setting: Three medical-surgical intensive care units.

Patients: All difficult-to-wean patients (defined as failure to tolerate the first 2-hr T-tube trial), mechanically ventilated for >48 hrs, were extubated after undergoing a two-step weaning protocol (measurements of predictors followed by a T-tube trial). Extubation failure was defined as the need of reintubation within 48 hrs.

Interventions: The weaning protocol evaluated hemodynamic and ventilation parameters, and arterial and venous gases during mechanical ventilation (immediately before T-tube trial), and at the 30th min of spontaneous breathing trial.

Measurements and Main Results: Seventy-three patients were enrolled in the study over a 6-mo period. Reintubation rate was 42.5%. Analysis by logistic regression revealed that central venous saturation was the only variable able to discriminate outcome of extubation. Reduction of central venous saturation by >4.5% was an independent predictor of reintubation, with odds ratio of 49.4 (95% confidence interval 12.1–201.5), a sensitivity of 88%, and a specificity of 95%. Reduction of central venous saturation during spontaneous breathing trial was associated with extubation failure and could reflect the increase of respiratory muscles oxygen consumption.

Conclusions: Central venous saturation was an early and independent predictor of extubation failure and may be a valuable accurate parameter to be included in weaning protocols of difficult-to-wean patients.

From the Intensive Care Unit (CT, NBdS, AS, RPO, RVC, TFT, MABB, JGM, RW, LGB), Moinhos de Vento Hospital, Porto Alegre, Brazil; Central-Intensive Care Unit (CT, GF, RPO), Santa Casa Hospital, Porto Alegre, Brazil; and the Intensive Care Unit (SRRV, LAN, GF, MABB), Clínicas Hospital, Porto Alegre, Brazil.

Gaúcho Weaning Study Group: Kamile Borba Pinto, RPT; Fernanda Callefe Moreira, RPT; Eubrando Silvestre Oliveira, MD; Flavio Cardona Alves, MD; Jorge Amilton Höher, MD; Cristiane Trevisan, RPT; Sérgio Fernando Monteiro Brodt, MD; José Hervê Diel Barth, MD; André Santana Machado, MD; Fabiano Leichsenring, RPT; Patrícia de Campos Balzano, MD; Luciano Marques Furlanetto, MD; José Fernando Pires, MD; Eduardo Monteiro da Silva, MD; Régis Bueno Albuquerque, MD; Daniele Munareto Dallegrave, MD; Marcelo Jeffman, MD; Sandro Cadaval Gonçalves, MD; Eduardo de Oliveira Fernandes, PhD; Marcelo Garcia da Rocha, MD; Maicon Becker, MD; Sergio Pinto Ribeiro, PhD; Alexandre Cordella da Costa, MD; Marcelo de Mello Rieder, RPT; Marisa Helena Pilenghi Correa, MD; Cristiane Magalhães Siqueira de Campos Morais, MD; Paulo José Zimmermann Teixeira, PhD; Márcio Pereira Hetzel, MD; André Petit Torelly, MD; Roger Weingartner, MD; Patrícia Pickersgill de Leon, MD; Joyce Michele Silva, RPT.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: cassiano.rush@terra.com.br

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins