Outcome of reintubated patients after scheduled extubation

doi:10.1016/j.jcrc.2010.12.015

Journal of Critical Care

Volume 26, Issue 5, October 2011, Pages 502-509

https://doi.org/10.1016/j.jcrc.2010.12.015 Get rights and content

Abstract

Purpose

The main objective of study was to evaluate the outcome of patients who require reintubation after elective extubation.

Materials and Methods

This is an observational, prospective cohort study including mechanically ventilated patients who passed successfully a spontaneous breathing trial. Patients were observed for 48 hours after extubation. During this time, reintubation or use of noninvasive positive pressure ventilation was considered as a failure. Reintubated patients were followed after the reintubation to register complications and outcome.

Results

A total of 1,152 extubated patients were included in the analysis. Three hundred thirty-six patients (29%) met the criteria for extubation failure. Extubation failure was independently associated with mortality (odds ratio, 3.29; 95% confidence interval, 2.19-4.93). One hundred eighty patients (16% of overall cohort) required reintubation within 48 hours after extubation. Median time from extubation to reintubation was 13 hours (interquartile range, 6-24 hours). Reintubation was independently associated with mortality (odds ratio, 5.18; 95% confidence interval, 3.38-7.94; P < .001). Higher mortality of reintubated patients was due to the development of complications after the reintubation.

Conclusions

In a large cohort of scheduled extubated patients, one third of patients developed extubation failure, of whom half needed reintubation. Reintubation was associated with increased mortality due to the development of new complications after reintubation.

Introduction

Postextubation respiratory failure after elective discontinuation of mechanical ventilation is a common event associated with significant morbidity and mortality [1]. Reintubation, which occurs in 6% to 23% within 48 to 72 hours after planned extubation [1], is a relevant consequence of respiratory failure after extubation. Patients who require reintubation have been noted to have a significantly higher mortality rate than those who are successfully extubated on the first attempt [2], [3]. Limited data are available regarding the reasons associated with mortality after extubation failure.

We studied a prospective cohort of mechanically ventilated patients who were electively extubated following current criteria for weaning. The main objective of this study was to evaluate the variables associated to mortality in reintubated patients.

Section snippets

Patients

Patients older than 18 years, who had undergone mechanical ventilation for more than 48 hours, and who had been scheduled extubated after a successful spontaneous breathing trial were enrolled from 36 intensive care units in 7 countries from September 2005 to December 2006 (see Appendix for the list of investigators). Patients with a tracheostomy were excluded. Because of the observational, noninterventionist design of the study, the research ethics board waived the need for informed consent.

Follow-up

Results

During the study period, 1152 scheduled extubated patients were included (Fig. 1). From this cohort, 336 patients (29%) met the criteria for extubation failure. In Table 1, the baseline characteristics of the study cohort are shown. Patients with extubation failure were older, had higher severity of illness, and were more likely to have been admitted with pneumonia, as reason for mechanical ventilation. These patients had a statistically significant—although with little clinical relevance—worse

Discussion

The main finding of our study was that death in reintubated patients was associated with complications and organ failures that developed after reintubation.

As in other studies [2], [8], [9], [10], [11], [12], [13], [14], [15], [16], we observed that both extubation failure and reintubation were associated with increased mortality. Several reasons have been suggested to explain this relationship [1]. First is the act of intubation itself. The death attributable to intubation, in the studies,

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^☆: Funding source. This work was supported by the CIBER Enfermedades Respiratorias from Instituto Carlos III, Spain.

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Outcomes/PredictorsOutcome of reintubated patients after scheduled extubation☆

Abstract

Purpose

Materials and Methods

Results

Conclusions

Introduction

Section snippets

Patients

Follow-up

Results

Discussion

Chest

Lancet

Crit Care Resusc

Ann Fr Anesth Reanim

Extubation

Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation

Am J Respir Crit Care Med

The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients

Am J Respir Crit Care Med

A comparison of four methods of weaning patients from mechanical ventilation

N Engl J Med

Weaning from mechanical ventilation

Eur Respir J

The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure

Intensive Care Med

Extubation failure: magnitude of the problem, impact on outcomes, and prevention

Curr Opin Crit Care

Noninvasive positive-pressure ventilation for respiratory failure after extubation

N Engl J Med

Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial

Am J Respir Crit Care Med

Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients

Eur Respir J

Outcomes/Predictors
Outcome of reintubated patients after scheduled extubation☆