Extubation failure (EF) has been associated with poor intensive care unit (ICU) outcome. Large surveys report that 10 to 15% reintubation rates (RRt) are typical for ICUs. The intent of this study was to identify RRt and impact of EF on outcomes of medical ICU (MICU) patients in our institution.
Observational, retrospective cohort study-data was gathered in MICU patients in a tertiary care non-university teaching hospital. All adult MICU patients from 1/1/2007 to 12/31/2007 who required mechanical ventilation via an endotracheal tube for more than 12 hours were included. EF was defined as reintubation within 72 hours. The control cohort included patients who were successfully extubated (SE) at 72 hours. The primary outcome was ICU length of stay (LOS) after initial intubation. Secondary outcomes were hospital LOS, ICU mortality, hospital mortality, VAP rate (per 1000 vent days), tracheostomy rate, average duration of intubation (ventilator days), and time to tracheostomy.
446 patients were included of which 209 SE and 28 had EF. Our RRt was 11.8%. Patients groups were similar in terms of age, sex, and severity of illness, as assessed using admission APACHE III score (P > 0.05). The ICU mortality, ICU LOS, ventilator days, and VAP rate were: 28.6%; 18.4 ± 10.3; 12 ± 7.8; and 11.94 in the EF patients and: 4.3%; 6.83 ± 4.64; 4.3 ± 3.5, and 9.53 in SE patients respectively. The corresponding P values were: 0.051; < 0.0001; < 0.0001; and 0.61. The main reason for EF (28.5%) was the inability to adequately protect airways or excessive secretions.
Our RRt is similar to that reported by other institutions. Our preliminary data analysis reveals that EF patients had worse outcomes than SE patients although some outcome measures did not reach statistical significance. EF is associated with prolonged inpatient care and ICU mortality. Extubation failure is an important ICU complication because of its associated significant poor patient outcomes.
The adverse outcomes of EF highlight the importance of accurate predictors of successful extubation.
Polina Inkoulova, No Financial Disclosure Information; No Product/Research Disclosure Information