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VOLUME 21 , ISSUE 3 ( 2017 ) > List of Articles


Factors Associated with Reintubation in an Intensive Care Unit: A Prospective Observational Study

Eric Shih Hsiung Lee, Danny Tse Jiann Lim, Juvel Mabao Taculod, Juliet Tolentino Sahagun, Joerie Pasive Otero, Kaimin Teo, Will Ne-Hooi Loh, Addy Yong Hui Tan

Keywords : Extubation failure, mechanical ventilation, risk factors

Citation Information : Lee ES, Lim DT, Taculod JM, Sahagun JT, Otero JP, Teo K, Loh WN, Tan AY. Factors Associated with Reintubation in an Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2017; 21 (3):131-137.

DOI: 10.4103/ijccm.IJCCM_452_16

License: CC BY-ND 3.0

Published Online: 01-02-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Background and Aims: The objective of the study was to determine the incidence of failed extubations in our Intensive Care Unit (ICU) and identify associated clinical factors. Materials and Methods: A prospective observational study of mechanically ventilated patients who underwent extubation attempts in our (predominantly surgical) ICU was undertaken from July 2012 to August 2013. The primary endpoint was the need for nonelective reintubation within 72 h of extubation. Clinical data of the reintubated patients were compared with those who were successfully extubated to identify factors associated with reintubation. Results: Five hundred and eight extubation attempts were documented, 38 (7.5%) of which were unsuccessful. On multivariate analysis, the following clinical factors were found to be associated with an increased risk of failed extubation: unplanned extubations (adjusted odds ratio [OR] 5.8), the use of noninvasive ventilation (NIV) postextubation (adjusted OR 3.2), and sepsis (adjusted OR 2.9). Patient demographic factors, other premorbid and comorbid medical conditions, and differences of laboratory parameters did not appear to significantly influence reintubation rates in our study. Conclusions: Our study has demonstrated a relatively low reintubation rate, likely due to inclusion of elective admissions/intubations in our patient population. Unplanned extubations, the use of NIV postextubation, and sepsis were associated with increased reintubation risk, reinforcing the need for increased vigilance in this subgroup of patients after extubation.

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  1. Nichol A, Duff S, Pettila V, Cooper DJ. What is the optimal approach to weaning and liberation from mechanical ventilation? In: Deutschman CS, Neligan PJ, editors. Evidence-Based Practice of Critical Care. 2nd ed. Philadelphia, PA: Elsevier; 2016. p. 52-60.
  2. Krinsley J, Reddy P, Iqbal A. Case-control study of failed extubation. Crit Care 2012;16 Suppl 1:128.
  3. Beckmann U, Gillies DM. Factors associated with reintubation in intensive care: An analysis of causes and outcomes. Chest 2001;120:538-42.
  4. Kulkarni AP, Agarwal V. Extubation failure in Intensive Care Unit: Predictors and management. Indian J Crit Care Med 2008;12:1-9.
  5. Meade M, Guyatt G, Cook D, Griffith L, Sinuff T, Kergl C, et al. Predicting success in weaning from mechanical ventilation. Chest 2001;120 6 Suppl: 400S-24S.
  6. Liu Y, Wei LQ, Li GQ, Lv FY, Wang H, Zhang YH, et al. A decision-tree model for predicting extubation outcome in elderly patients after a successful spontaneous breathing trial. Anesth Analg 2010;111:1211-8.
  7. Krinsley JS, Reddy PK, Iqbal A. What is the optimal rate of failed extubation? Crit Care 2012;16:111.
  8. Mokhlesi B, Tulaimat A, Gluckman TJ, Wang Y, Evans AT, Corbridge TC. Predicting extubation failure after successful completion of a spontaneous breathing trial. Respir Care 2007;52:1710-7.
  9. Miu T, Joffe AM, Yanez ND, Khandelwal N, Dagal AH, Deem S, et al. Predictors of reintubation in critically ill patients. Respir Care 2014;59:178-85.
  10. Wang S, Zhang L, Huang K, Lin Z, Qiao W, Pan S. Predictors of extubation failure in neurocritical patients identified by a systematic review and meta-analysis. PLoS One 2014;9:e112198.
  11. Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med 1999;27:340-7.
  12. Demling RH, Read T, Lind LJ, Flanagan HL. Incidence and morbidity of extubation failure in surgical intensive care patients. Crit Care Med 1988;16:573-7.
  13. Engoren M, Buderer NF, Zacharias A, Habib RH. Variables predicting reintubation after cardiac surgical procedures. Ann Thorac Surg 1999;67:661-5.
  14. Daley BJ, Garcia-Perez F, Ross SE. Reintubation as an outcome predictor in trauma patients. Chest 1996;110:1577-80.
  15. Frutos-Vivar F, Ferguson ND, Esteban A, Epstein SK, Arabi Y, Apezteguía C, et al. Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 2006;130:1664-71.
  16. Rothaar RC, Epstein SK. Extubation failure: Magnitude of the problem, impact on outcomes, and prevention. Curr Opin Crit Care 2003;9:59-66.
  17. Lee PJ, MacLennan A, Naughton NN, O'Reilly M. An analysis of reintubations from a quality assurance database of 152,000 cases. J Clin Anesth 2003;15:575-81.
  18. Balon JA. Common factors of spontaneous self-extubation in a critical care setting. Int J Trauma Nurs 2001;7:93-9.
  19. Epstein SK, Nevins ML, Chung J. Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med 2000;161:1912-6.
  20. Boulain T. Unplanned extubations in the adult Intensive Care Unit: A prospective multicenter study. Association des Réanimateurs du Centre-Ouest. Am J Respir Crit Care Med 1998;157(4 Pt 1):1131-7.
  21. Mort TC. Unplanned tracheal extubation outside the operating room: A quality improvement audit of hemodynamic and tracheal airway complications associated with emergency tracheal reintubation. Anesth Analg 1998;86:1171-6.
  22. Betbesé AJ, Pérez M, Bak E, Rialp G, Mancebo J. A prospective study of unplanned endotracheal extubation in Intensive Care Unit patients. Crit Care Med 1998;26:1180-6.
  23. Phoa LL, Pek WY, Syap W, Johan A. Unplanned extubation: A local experience. Singapore Med J 2002;43:504-8.
  24. Atkins PM, Mion LC, Mendelson W, Palmer RM, Slomka J, Franko T. Characteristics and outcomes of patients who self-extubate from ventilatory support: A case-control study. Chest 1997;112:1317-23.
  25. Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A. Early noninvasive ventilation averts extubation failure in patients at risk: A randomized trial. Am J Respir Crit Care Med 2006;173:164-70.
  26. Kee A, Phua J, Huang Y, Dela Pena E, Santiago E, Santos J, et al. A five-year series on the use of noninvasive ventilation as a weaning tool from invasive ventilation. Eur Respir J 2011;38 Suppl 55:2065.
  27. Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 2001;120:1262-70.
  28. Schönhofer B, Wenzel M, Geibel M, Köhler D. Blood transfusion and lung function in chronically anemic patients with severe chronic obstructive pulmonary disease. Crit Care Med 1998;26:1824-8.
  29. Schönhofer B, Böhrer H, Köhler D. Blood transfusion facilitating difficult weaning from the ventilator. Anaesthesia 1998;53:181-4.
  30. Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999;340:409-17.
  31. Holst LB, Haase N, Wetterslev J, Wernerman J, Guttormsen AB, Karlsson S, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 2014;371:1381-91.
  32. Lee KH, Hui KP, Chan TB, Tan WC, Lim TK. Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome. Chest 1994;105:540-3.
  33. Edmunds S, Weiss I, Harrison R. Extubation failure in a large pediatric ICU population. Chest 2001;119:897-900.
  34. Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical Intensive Care Unit patients. Crit Care Med 2011;39:2612-8.
  35. El Solh AA, Bhat A, Gunen H, Berbary E. Extubation failure in the elderly. Respir Med 2004;98:661-8.
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