Central Venous-to-Arterial Pco2 Difference and Central Venous Oxygen Saturation in the Detection of Extubation Failure in Critically Ill Patients

Abstract

Objectives: To evaluate the ability of central venous-to-arterial carbon dioxide pressure difference, central venous oxygen saturation, and the combination of these two parameters to detect extubation failure in critically ill patients. Design: Multicentric, prospective, observational study. Setting: Three ICUs. Patients: All patients who received mechanical ventilation for more than 48 hours and tolerated spontaneous breathing trials with a T-piece for 60 minutes. Interventions: Extubation after successful spontaneous breathing trials. Extubation failure was defined as the need for mechanical ventilation within 48 hours. Measurements and Main Results: The oxygen delivery index, oxygen consumption index, central venous oxygen saturation, central venous-to-arterial carbon dioxide pressure difference, and oxygen extraction were measured immediately before spontaneous breathing trials and at 60 minutes after spontaneous breathing trials initiation. Seventy-five patients were enrolled, and extubation failure was noted in 18 (24%) patients. Oxygen consumption index increased significantly during spontaneous breathing trials in the failure group. Oxygen delivery index increased in both success and failure groups. Oxygen extraction increased in the failure group (p= 0.005) and decreased in the success group (p= 0.001). Central venous oxygen saturation decreased in the failure group and increased in the success group (p= 0.014). Delta Pco(2)value increased in the extubation failure group and decreased in the success group (p= 0.002). Changes in Delta Pco(2)(Delta - Delta PCO2) and central venous oxygen saturation (Delta ScvO(2)) during spontaneous breathing trials were independently associated with extubation failure (odds ratio, 1.02; 95% CI, 1.01-1.05;p= 0.006, and odds ratio, 0.84; 95% CI, 0.70-0.95;p= 0.02, respectively). Delta - Delta PCO(2)and central venous oxygen saturation could predict extubation failure with areas under the curve of 0.865 and 0.856, respectively; however, their combined areas under the curve was better at 0.940. Conclusions: We found that Delta - Delta Pco(2)and central venous oxygen saturation, during spontaneous breathing trials, were independent predictors of weaning outcomes. Combination analysis of both parameters enhanced their diagnostic performance and provided excellent predictability in extubation failure detection in critically ill patients.