Objective:To explore the predictive factors for failed extubation in patients with chronic obstruc-tive pulmonary disease(COPD)undergoing mechanical ventilation.Methods:Eighty patients undergo-ing tracheal intubation mechanical ventilation during acute exacerbation of COPD were collected and were divided into the extubation success group(62 cases)and extubation failure group(18 cases)based on whether tracheal intubation was successfully removed.The differences in various indicators be-tween the two groups were compared,and multivariable logistic regression analysis and receiver opera-tor characteristic(ROC)curve analysis were used to analyze the factors affecting the outcome of extuba-tion.Results:The pre-spontaneous breathing trial(SBT)inferior vena cava collapse index(IVCCI)and post-SBT oxygenation index(PaO2/FiO2)and IVCCI were higher in the extubation success group than in the extubation failure group(P<0.05).The pre-SBT lung ultrasound score,24-hour fluid balance,and post-SBT heart rate(HR),respiratory rate(RR),lung ultrasound score,PaCO2,and 24-hour fluid balance were lower in the extubation success group than in the extubation failure group(P<0.05).Mul-tivariable logistic regression analysis showed that increased RR after SBT and positive balance of 24-hour fluid were independent risk factors for failed extubation.Increased IVCCI after SBT was a protec-tive factor for successful extubation.The ROC curve analysis showed that the predictive values of RR,24-hour fluid balance,and IVCCI after SBT for the outcome of extubation in COPD patients undergoing mechanical ventilation were 0.919,0.730,and 0.752,respectively,with the optimal cut-off values of 20.5 beats/min,-329 mL,and 24.26%,respectively.The combined predictive value of the three in predicting the outcome of extubation in COPD patients undergoing mechanical ventila-tion was 0.989,with a sensitivity of 0.919 and a specificity of 1.000.Conclusion:Increased RR after SBT and positive balance of 24-hour fluid are independent risk factors for failed extubation.RR,24-hour fluid balance,and IVCCI after SBT have good predictive value for the outcome of extubation in COPD patients undergoing mechanical ventilation,and their combined predictive value is greater.
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