Article Dans Une Revue Chest Année : 2024

Incidence, risk factors and long-term outcomes for extubation failure in intensive care unit in patients with obesity A retrospective analysis of a multicenter prospective observational study.

1 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
2 Hôpital Saint Eloi [CHU Montpellier]
3 HUG - Hôpitaux Universitaires de Genève = University Hospital of Geneva [Genève]
4 UNIGE - Université de Genève = University of Geneva
5 Service d'anesthésie et réanimation chirurgicale [Nantes]
6 Nantes Univ - Nantes Université
7 Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse
8 Hôpital Hôtel-Dieu [CHU Nantes]
9 Hôpital Beaujon [AP-HP]
10 USPC - Université Sorbonne Paris Cité
11 CARMAS - Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis)
12 Hôpital Henri Mondor
13 CHU Angers - Centre Hospitalier Universitaire d'Angers
14 CH Argenteuil - Centre hospitalier Victor Dupouy [Centre hospitalier d'Argenteuil]
15 CH Le Puy - Centre Hospitalier Emile Roux [Le Puy-en-Velay]
16 FMTS - Fédération de Médecine Translationnelle de Strasbourg
17 Hôpital de Hautepierre [Strasbourg]
18 MSP - Mitochondrie, Stress oxydant et Protection musculaire
19 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
20 IDESP - Institut Desbrest d'Epidémiologie et de Santé Publique
21 PREMEDICAL - Médecine de précision par intégration de données et inférence causale
22 Hôpital Nord [CHU - APHM]
23 AMU - Aix Marseille Université
24 URMITE - Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes
25 UPCité - Université Paris Cité
26 AP-HP - Hopital Saint-Louis [AP-HP]
Christophe Guitton

Résumé

BACKGROUND: To our knowledge, no large observational study has compared the incidence and risk factors for extubation failure within 48 h and during ICU stay in the same cohort of unselected critically ill patients with and without obesity. RESEARCH QUESTION: What are the incidence and risk factors of extubation failure in patients with and without obesity? STUDY DESIGN AND METHODS: In the prospective multicenter observational Practices and Risk Factors for Weaning and Extubation Airway Failure in Adult Intensive Care Unit: A Multicenter Trial (FREEREA) study in 26 ICUs, the primary objective was to compare the incidence of extubation failure within 48 h in patients with and without obesity. Secondary objectives were to describe and to identify the independent specific risk factors for extubation failure using first a logistic regression model and second a decision tree analysis. RESULTS: Of 1,370 extubation procedures analyzed, 288 (21%) were performed in patients with obesity and 1,082 (79%) in patients without obesity. The incidence of extubation failure within 48 h among patients with or without obesity was 23 of 288 (8.0%) vs 118 of 1,082 (11%), respectively (unadjusted OR, 0.71; 95% CI, 0.45-1.13; P ¼ .15); alongside patients with obesity receiving significantly more noninvasive ventilation [87 of 288 (30%) vs 233 of 1,082 (22%); P ¼ .002] and physiotherapy [165 of 288 (57%) vs 527 of 1,082 (49%); P ¼ .02] than patients without obesity. Risk factors for extubation failure also differed according to obesity status: female sex (adjusted OR, 4.88; 95% CI, 1.61-13.9; P ¼ .002) and agitation before extubation (adjusted OR, 6.39; 95% CI, 1.91-19.8; P ¼ .001) in patients with obesity, and absence of strong cough before extubation (adjusted OR, 2.38; 95% CI, 1.53-3.84; P ¼ .0002) and duration of invasive mechanical ventilation before extubation (adjusted OR, 1.03/d; 95% CI, 1.01-1.06; P ¼ .01) in patients without obesity. The decision tree analysis found similar risk factors. INTERPRETATION: Our findings indicate that anticipation and application of preventive measures for patients with obesity before and after extubation led to similar rates of extubation failure among patients with and without obesity.

NCT XXX.

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hal-04680810 , version 1 (26-01-2026)

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Audrey de Jong, Mathieu Capdevila, Yassir Aarab, Matthieu Cros, Joris Pensier, et al.. Incidence, risk factors and long-term outcomes for extubation failure in intensive care unit in patients with obesity A retrospective analysis of a multicenter prospective observational study.. Chest, 2024, 167 (1), pp.139-151. ⟨10.1016/j.chest.2024.07.171⟩. ⟨hal-04680810⟩
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