Patients can safely be extubated while still on vasoactive infusions, according to a recent study published in the American Journal of Respiratory and Critical Care Medicine.
Researchers of this retrospective study assessed patients who were extubated while still on vasoactive infusions (n=280) and patients who were extubated after termination of vasoactive infusions (n=986). All patients were intubated between January 2007 and February 2017. The focus of this work was to evaluate the difference in mortality rates, reintubation frequencies, and lengths of hospital stay of the two groups.
Both treatment groups had comparable intensive care unit (ICU) mortality rates (6.4% vs 8.1%) and ICU reintubation rates (10.7% vs 12.2%). Overall outcomes of hospital mortality (adjusted P =.0805), unit mortality (adjusted P =.332), and reintubation (adjusted P =.8383) were similar between both groups.
Patients on vasoactive infusions did have slightly shorter intensive care unit stays (5 vs 9 days; P <.001) and periods of mechanical ventilation (2 vs 6 days; P <.001). This could be due to the reduction in complications because of a shorter duration of intubation.
In conclusion, these results indicated patients can safely be extubated while on vasoactive infusions, although they did not show that extubation while on vasoactive agents is always equally safe as other extubations; further research needs to identify protocols for categorizing ideal patients.
Quasim T, Shaw M, McPeake J, Hughes M, Iwashyna TJ. Safety of extubating mechanically ventilated patients on vasoactive infusions: a retrospective cohort study [published online June 28, 2018]. Am J Respir Crit Care Med. doi:10.1164/rccm.201712-2492LE