Introduction: Reports on reintubation have focused on
patients in whom planned extubation has been unsuccessful or those who
have been accidentally extubated. However, reintubation is often
required in events not related to accidental extubation. These cases
have not been well described previously.
To examine the causes, outcomes, and contributing factors associated
with patients who required reintubation for events not including
reintubation incidents were extracted from the Australian Incident
Monitoring Study in Intensive Care database and analyzed using
Results: One hundred
forty-three incidents were identified with prominent precipitating
events, including tube malposition (17%), securing/taping problems
(17%), pilot tube/cuff problem (16%), blocked/kinked airway (14%),
failed extubation (14%), and poor planning for extubation (6%).
Narrative description of morbidity included hypoxia in 25% of reports,
hypercarbic respiratory failure in 12%, aspiration in 7%, sputum
retention in 7%, and cardiac arrhythmias in 6%. The reporter selected“
major physiologic complications” and “prolonged hospital stay”
as prominent adverse outcomes in 52% and 16% of patients,
respectively. Major factors contributing to reintubation involved“
error of judgement/problem recognition” (identified in 62% of
reports), “high unit activity” (20%), “difficult patient
habitus” (26%), and “lack of patient cooperation” (14%).
Rechecking patient and equipment, and skilled assistance were prominent
factors in limiting the adverse consequences of the incident.
Conclusion: This study indicated that reintubation not
related to accidental extubation resulted in major physiologic
complications and potentially contributed to increased length of stay.
Its findings suggest that the adequate provision of highly qualified,
intensive-care-trained staff is essential for the avoidance or
minimization of these incidents.