Association Between Sputum Consistency and Extubation in Mechanically Ventilated Patients with Severe Pneumonia...

Thick airway secretions may impair airway clearance and contribute to extubation failure in mechanically ventilated patients with severe pneumonia. Bedside sputum consistency assessment is commonly used in intensive care unit (ICU) practice, but its relationship with extubation outcomes remains insufficiently studied. Thus, we conducted a single-center prospective observational study of 80 mechanically ventilated adults with severe pneumonia who received nebulized sulfadiazine-polymyxin B as part of ICU care. Bedside sputum consistency was assessed using a semi-quantitative clinical scale before and after therapy. Change in bedside sputum consistency score was defined as the pre-treatment score minus the post-treatment score. The primary outcome was extubation success, defined as removal of the endotracheal tube without reintubation within 72 h. Nebulizer type, clinical characteristics, ventilator parameters, microbiological findings, and outcomes were recorded. Multivariable logistic regression was used to evaluate the association between changes in consistency and extubation success. Eighty patients were included: 27 received jet nebulization, 23 mesh nebulization, and 30 ultrasonic nebulization. Extubation success occurred in 50 patients. Patients with successful extubation had a greater improvement in the bedside sputum consistency score than patients without successful extubation (1.28 ± 0.78 vs 0.63 ± 1.00; p = 0.004). In a baseline-adjusted analysis, successful extubation was associated with a 0.63-point lower post-treatment score (adjusted mean difference, -0.63; 95% CI, -1.06 to -0.21; p = 0.003). In the parsimonious multivariable analysis, greater improvement in the bedside sputum consistency score remained associated with successful extubation (OR, 2.90; 95% CI, 1.51-5.56; p = 0.001), whereas baseline score was not independently associated with the outcome. Nebulizer type was not significantly associated with extubation success. In conclusion, the mechanically ventilated patients with severe pneumonia receiving nebulized sulfadiazine-polymyxin B, greater improvement in bedside sputum consistency was associated with successful extubation. Bedside secretion assessment may provide useful supportive information during extubation readiness evaluation. Further controlled studies using standardized and objective rheological measurements are warranted.