Occurrence and Complications of Tracheal Reintubation in Critically Ill Adults

Menon, Nithya; Joffe, Aaron M.; Deem, Steven; Yanez, N. David; Grabinsky, Andreas; Dagal, Armagan; Daniel, Stephen; Treggiari, Miriam M.

doi:10.4187/respcare.01617

Cited by 69 publications

(71 citation statements)

References 19 publications

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“…Details of the study population have been previously reported. 5 Overall, the subjects were 49.5 Ϯ 17.9 years of age, 66% were male, and the mean SAPS II score was 39.4 Ϯ 15.2. Subjects who required reintubation any time during their ICU or hospital stay tended to be older and have a higher mean SAPS II.…”

Section: Resultsmentioning

confidence: 94%

“…A recent study at our institution examined fluid balance in patients with subarachnoid hemorrhage, and suggested extensive day-to-day variability in the response to fluid administration. 18 We defined early extubation failure as reintubation within 24 hours, as the median time to reintubation was 22 hours, 5 thereby capturing more than half of extubation failures within this window. Furthermore, 24 hours is an important post-extubation milestone in the decision to transfer a patient out of the ICU after liberation from mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Nonetheless, even after passing an SBT, nearly one in 5 will require reintubation at some time during the hospital stay, with half of these patients requiring reintubation within the first 24 hours. 3,5 Salam et al 6 reported the ability to maintain a patent upper airway and clear secretions, indicated by a cough peak SEE THE RELATED EDITORIAL ON PAGE 301 flow Ͼ 60 L/min, tracheal secretions Ͻ 2.5 mL/min, and the ability to follow 4 simple tasks (ie, open eyes, track with eyes, grasp with hands, and stick out tongue) increased the odds of successful extubation. Mokhlesi and colleagues 7 reported on 122 patients who were followed after extubation to identify those who were reintubated within 48 hours.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Reintubation in Critically Ill Patients

et al. 2013

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BACKGROUND: Assessment of a patient's readiness for removal of the endotracheal tube in the ICU is based on respiratory, airway, and neurological measures. However, nearly 20% of patients require reintubation. We created a prediction model for the need for reintubation, which incorporates variables importantly contributing to extubation failure. METHODS: This was a cohort study of 2,007 endotracheally intubated subjects who required ICU admission at a tertiary care center. Data collection included demographic, hemodynamic, respiratory, and neurological variables preceding extubation. Data were compared between subjects extubated successfully and those who required reintubation, using bivariate logistic regression models, with the binary outcome reintubation and the baseline characteristics as predictors. Multivariable logistic regression analysis with robust variance was used to build the prediction model. RESULTS: Of the 2,007 subjects analyzed, 376 (19%) required reintubation. In the bivariate analysis, admission Simplified Acute Physiology Score II, minute ventilation, breathing frequency, oxygenation, number of prior SBTs, rapid shallow breathing index, airway-secretions suctioning frequency and quantity, heart rate, and diastolic blood pressure differed significantly between the extubation success and failure groups. In the multivariable analysis, higher Simplified Acute Physiology Score II and suctioning frequency were associated with failed extubation. The area under the receiver operating characteristic curve was 0.68 for failure at any time, and 0.71 for failure within 24 hours. However, prior failed SBT, minute ventilation, and diastolic blood pressure were additional independent predictors of failure at any time, whereas oxygenation predicted extubation failure within 24 hours. CONCLUSIONS: A small number of independent variables explains a substantial portion of the variability of extubation failure, and can help identify patients at high risk of needing reintubation. These characteristics should be incorporated in the decision-making process of ICU extubation.

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Section: Resultsmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of Reintubation in Critically Ill Patients

et al. 2013

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“…13 Identifying the clinical characteristics that are predictors of reintubation is important for caregivers. As demonstrated by Smina and colleagues, 5 CPF is an independent predictor of reintubation.…”

Section: Discussionmentioning

confidence: 99%

Semiquantitative Cough Strength Score for Predicting Reintubation After Planned Extubation

Duan

Zhou

Xiao

et al. 2015

American Journal of Critical Care

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Background Semiquantitative cough strength score (SCSS, graded 0-5) and cough peak flow (CPF) have been used to predict extubation outcome in patients in whom extubation is planned; however, the correlation of the 2 assessments is unclear. Methods In the intensive care unit of a universityaffiliated hospital, 186 patients who were ready for extubation after a successful spontaneous breathing trial were enrolled in the study. Both SCSS and CPF were assessed before extubation. Reintubation was recorded 72 hours after extubation. Results Reintubation rate was 15.1% within 72 hours after planned extubation. Patients in whom extubation was successful had higher SCSSs than did reintubated patients (mean [SD] , and 5, respectively. The discriminatory power for reintubation, evidenced by area under the receiver operating characteristic curve, was similar: 0.677 for SCSS and 0.678 for CPF (P = .97). As SCSS increased (from 0 to 1 to 2 to 3 to 4 to 5), the reintubation rate decreased (from 29.4% to 25.0% to 19.4% to 16.1% to 13.2% to 4.1%). Conclusions SCSS was convenient to measure at the bedside. It was positively correlated with CPF and had the same accuracy for predicting reintubation after planned extubation. (American Journal of Critical Care. 2015;24:e86-e90)

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“…9,10 Furthermore, re-intubation is associated with a 5-fold increase in the relative odds of death and a 2-fold increase in median ICU and hospital stay, as well as institutional costs. 11 Thus, avoiding reintubation is important.…”

Section: Introductionmentioning

confidence: 99%

Voluntary Is Better Than Involuntary Cough Peak Flow for Predicting Re-Intubation After Scheduled Extubation in Cooperative Subjects

et al. 2014

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BACKGROUND:In this study, we compared the predictive accuracy of voluntary cough peak flow (V-CPF) and involuntary cough peak flow (IV-CPF) for re-intubation in mechanically ventilated subjects. METHODS: Endotracheally intubated patients who passed a spontaneous breathing trial and assessment of readiness for extubation were enrolled. Before extubation, V-CPF and IV-CPF were measured. Re-intubation was recorded at 72 h after extubation. RESULTS: A total of 115 extubations in 106 cooperative subjects (including 9 subjects with second extubation) and 5 extubations in 5 uncooperative subjects were recorded. At 72 h, 20 (17.4%) and 1 (25%) instances of re-intubation occurred in cooperative and uncooperative subjects, respectively. In cooperative subjects, those who had been successfully extubated had higher V-CPF than re-intubated subjects

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Occurrence and Complications of Tracheal Reintubation in Critically Ill Adults

Abstract: Nearly 20% of critically ill patients required out of operating room reintubation. Reintubation was associated with higher mortality, stay, and cost. Moreover, a difficult airway at reintubation was associated with higher mortality.

Cited by 69 publications

References 19 publications

Predictors of Reintubation in Critically Ill Patients

Predictors of Reintubation in Critically Ill Patients

Semiquantitative Cough Strength Score for Predicting Reintubation After Planned Extubation

Voluntary Is Better Than Involuntary Cough Peak Flow for Predicting Re-Intubation After Scheduled Extubation in Cooperative Subjects

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