Predictors of Respiratory Failure Following Extubation in the SICU

Both extubation delay and extubation failure are related to adverse outcomes. A spontaneous
breathing trial is therefore recommended to predict extubation readiness. However, depending
on the disease entity and local culture, a range of 10-20 per cent incidence of extubation
failure has been described from tertiary care hospitals. The aim of this trial is to
identify additional variables in surgical patients that can be used to support a clinician's
decision on whether or not to extubate a patient's trachea.

Te investigators have recently developed and validated the SPORC (Brueckmann, 2013), a score
that predicts the risk of extubation failure following surgery based on patients
comorbidities and the acuity of the disease leading to surgery, and the investigators
hypothesize that the SPORC will also predict extubation failure in the surgical ICU.

In addition, it is likely that ICU acquired morbidity also predicts extubation failure. In
fact, the investigators have recently shown that muscle weakness is a predictor of
aspiration (Mirzakhani, 2013), and the investigators speculated that muscle weakness may
also respiratory failure after extubation.

Finally, it has been suggested that the increased mortality seen in patients with acute
kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) versus end stage
renal disease (ESRD) patients requiring CRRT can be attributed to an increased need for
mechanical ventilation. (Walcher, 2011). Therefore, the investigators also hypothesize that
acute kidney injury increases the vulnerability of patients to postextubation respiratory
failure.

Inclusion Criteria:

- Adults (18 years of age or greater)

- Patients who have been extubated following mechanical ventilation in the surgical ICU

Exclusion Criteria:

- Preexisting end-stage renal disease

- Neurological disorder associated with severe muscle weakness

- Goals of care focused on comfort