Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era

Yun Cong Zheng, Yen Min Huang, Pin Yuan Chen, Hsiao Yean Chiu, Huang Pin Wu, Chien Ming Chu, Wei Siang Chen, Yu Cheng Kao, Ching Fang Lai, Ning Yi Shih, Chien Hong Lai

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We established 1-h and 1-day survival models after terminal extubation to optimize ventilator use and achieve a balance between critical care for COVID-19 and hospice medicine. Methods: Data were obtained from patients with end-of-life status at terminal extubation from 2015 to 2020. The associations between APACHE II scores and parameters with survival time were analyzed. Parameters with a p-value ≤ 0.2 in univariate analysis were included in multivariate models. Cox proportional hazards regression analysis was used for the multivariate analysis of survival time at 1 h and 1 day. Results: Of the 140 enrolled patients, 76 (54.3%) died within 1 h and 35 (25%) survived beyond 24 h. No spontaneous breathing trial (SBT) within the past 24 h, minute ventilation (MV) ≥ 12 L/min, and APACHE II score ≥ 25 were associated with shorter survival in the 1 h regression model. Lower MV, SpO2 ≥ 96% and SBT were related to longer survival in the 1-day model. Hospice medications did not influence survival time. Conclusion: An APACHE II score of ≥ 25 at 1 h and SpO2 ≥ 96% at 1 day were strong predictors of disposition of patients to intensivists. These factors can help to objectively tailor pathways for post-extubation transition and rapidly allocate intensive care unit resources without sacrificing the quality of palliative care in the era of COVID-19. Trial registration They study was retrospectively registered. IRB No.: 202101929B0.

Original languageEnglish
Article number21
JournalEuropean Journal of Medical Research
Volume28
Issue number1
DOIs
Publication statusPublished - Dec 2023

Keywords

  • APACHE II score
  • COVID-19
  • Hospice medicine
  • Intensive care unit
  • SpO2
  • Terminal extubation

ASJC Scopus subject areas

  • General Medicine

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