Kartika Juwita1, Gurmeet Singh2, Adhrie Sugiarto3, Hamzah Shatri4
1Department of Internal Medicine, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia
2Respirology and Critical Care Medicine Division, Dept.of Internal Medicine, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia
3Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia
4Psychosomatic Division, Department of Internal Medicine, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia
Background: Pneumonia is a common respiratory tract infection which is considered as one of the top causes of death. Patients with severe pneumonia often require intubation in order to achieve adequate ventilation. Extubation failure, however, is associated with increased complications and mortality. We aim to determine the predictors associated with extubation failure in patients with severe pneumonia.
Methods: A retrospective cohort study was conducted, which included patients with severe pneumonia intubated in the intensive care unit of Ciptomangunkusumo General Hospital over the period of 2015-2019. Patient characteristics, laboratory values and outcomes were retrieved from medical records. Relationships between variables and extubation outcomes were assessed in bivariate analysis and multivariate cox regression model.
Results: A total of 192 subjects with severe pneumonia was included in this study. Incidence of extubation failure among patients with severe pneumonia was 70.3%, with a mortality rate of 85.2%. Bivariate analyses found that age of >60 years, smoking history, moderate-to-severe Charlson Comorbidity Index, renal replacement therapy, not having neuromuscular disease, procalcitonin >2 ng/mL, and APACHE II score of ≥25 were associated with extubation failure. In multivariate analysis, moderate-to-severe Charlson Comorbidity Index (HR 2.254, 95% CI 1.353-3.755, p=0.002) and procalcitonin > 2 ng/mL (HR 1.859, 95% CI 1.037-3.333) were found to be independent predictors of extubation failure in patients with severe pneumonia.
Conclusion: Moderate-to-severe Charlson Comorbidity index and procalcitonin level of >2 ng/mL were independent predictors of extubation failure in patients with severe pneumonia.
Keywords: severe pneumonia, extubation failure, Charlson Comorbidity Index, procalcitonin