Accepted Manuscript

Factors predicting failure of noninvasive ventilation assist for

preventing reintubation among medical critically ill patients

Surat Tongyoo

PII: S0883-9441(17)30489-6
DOI: doi: 10.1016/j.jcrc.2017.08.001
Reference: YJCRC 52626
To appear in:
Revised date: ###REVISEDDATE###
Accepted date: ###ACCEPTEDDATE###

Please cite this article as: Surat Tongyoo , Factors predicting failure of noninvasive
ventilation assist for preventing reintubation among medical critically ill patients, (2017),
doi: 10.1016/j.jcrc.2017.08.001

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 ACCEPTED MANUSCRIPT

Response to a Letter to the Editor

Factors predicting failure of noninvasive ventilation assist for preventing

reintubation among medical critically ill patients

Corresponding author:

Surat Tongyoo

PT
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University,

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Bangkok 10700, Thailand.

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E-mail address: surat_Ty@yahoo.co.uk

Telephone: +66820137771; Fax: +6624198534

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MA

Competing interests

The authors declare no competing interests.

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Funding
PT

This study was supported by Siriraj Hospital Research funding for young
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investigators. The funders had no role in conducting or reporting of this study.

AC

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Response to a Letter to the Editor

To the Editor:

We appreciate the thoughtful review and constructive comments from Dr.

Gulsah Karaoren and colleagues regarding to our recently published article Factors
predicting failure of noninvasive ventilation assist for preventing reintubation
among medical critically ill patients[1]. The following is our respond to their

PT
critiques.
Although, we enrolled the wide range of patients age, starting from 18 years

RI
old, most of our patients were age over 60 years (table 1.). We did not record the

SC
patients baseline nutritional status, however; we did record the patients body mass
index (BMI). A recent study by Compher C, et al. demonstrated that BMI < 18.5
NU
kg/sq.m can be used as a parameter to diagnose malnutrition. Moreover, patient
with low BMI associated with higher hospital mortality rate, especially among
MA

Asian population [2]. The proportion of low BMI among failure NIV group was
slightly higher than the success group, but without statistically significant. From our
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additional data, the patient age and pre-existing malnourishment had no effect to the
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failure rate of non-invasive ventilation (NIV) to prevent re-intubation.

PT

We also used the rapid shallow breathing index (RSBI) as a predictor for
successfully discontinues the patient from the ventilator. RSBI before endotracheal
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extubation was shown in table 1. There was no significant different of RSBI

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between the success and failure group. Only 2 patients had RSBI more than 100,
one patient was in the success group. The proportion of the patient who had RSBI
before extubation over 50 was similar among the two groups.
As Dr. Karaoren noted, the shorter duration of mechanical ventilator
dependent day among septic shock and pneumonia, which were the majority of our
study population, may associate with failure extubation. We classified the patients
according to the duration of mechanical ventilator dependent, as shown in the table
1. There was no association of failure intubation and the shorter duration of

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 ACCEPTED MANUSCRIPT

mechanical ventilator dependent. From this additional information, it is less likely

that higher re-intubation in our study population could be explained by insufficient
duration of mechanical ventilation support.
We thank you for the opportunity to respond to Dr. Gulsah Karaoren and
colleagues comments. We hope that this additional data will improve our study
practical implications.

PT
Reference:

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1. Thomrongpairoj P, Tongyoo S, Tragulmongkol, Permpikul C. Factors
predicting failure of noninvasive ventilation assist for preventing reintubation

SC
among medical critically ill patients. J Crit Care 2017:38; 177-81.
NU
2. Compher C, Higashiguchi T, Yu J, Jensen G L. Does low body mass index
predict the hospital mortality of adult Western or Asian patients? JPEN J
MA

Parenter Enteral Nutr. 2017 Jun 1: [Epub ahead of print]

Table 1. Patients characters, comparing between successful and failure NIV for
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prevent re-intubation
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Success Failure P
Variable
(n = 57) (n = 48) value
CE

Age, y (mean SD) 63.6 17.1 63.0 19.1 0.88

Age > 60 years old (%) 64.9 68.8 0.68
BMI, kg/m2 (mean SD) 23.2 6.1 22.1 5.2 0.36
AC

BMI < 18.5 (%) 15.8 22.9 0.35

Rapid shallow breathing index (RSBI) 47.8 17.4 49.2 22.2 0.43
RSBI > 50 (%) 43.8 42.1 0.87
Mechanical ventilator duration, h 169.1 95.1 192.8 145.6 0.32
Mechanical ventilator duration <72 h (%) 14 18.8 0.51
Mechanical ventilator duration <120 h (%) 33.3 35.1 0.85

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