Clinical Utility of Carbon Dioxide Monitoring for Predicting Extubation Failure

The following is a summary of “End-tidal carbon dioxide during spontaneous breathing trial to predict extubation failure: A prospective observational study,” published in the December 2024 issue of Critical Care by May et al. 

Despite advancements in weaning protocols, extubation failure (EF) is linked to poor outcomes, with predictors like hypercapnia at the end of the spontaneous breathing test (SBT), though end-tidal carbon dioxide (EtCO₂) provides a continuous monitoring alternative.  

Researchers conducted a retrospective study to determine the clinical utility of EtCO₂ in predicting EF. 

They included patients undergoing planned extubation, excluding those with tracheostomy and those extubated after a successful T-tube SBT. Clinical data and EtCO₂ levels were recorded in 189 patients during a successful 1-hour low-pressure support SBT.  

The results showed that EtCO₂ measured before a successful SBT was lower in patients with EF compared to those with successful extubation (27 [24–29] vs. 30 [27–47] mmHg, P = 0.02). However, EtCO₂ at 5 minutes and at the end of SBT did not differ significantly between the groups (26 [22–28] vs 29 [28–49] mmHg, P = 0.06 and 26 [26–29] vs 29 [27–49] mmHg, P = 0.09, respectively). Multivariable analysis identified acute respiratory failure as the cause of intubation and ineffective cough as independent factors associated with EF.  

Investigators concluded that recording EtCO₂ during successful SBT demonstrated limited predictive value for subsequent EF. 

Source: sciencedirect.com/science/article/abs/pii/S0883944124003575 

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