Risk Factors Associated With Early Reintubation in Trauma Patients: A Prospective Observational Study

Brown, Carlos; Daigle, Jacob B.; Foulkrod, Kelli H.; Brouillette, Brandee; Clark, A. Clay; Czysz, Clea; Martinez, Marnie; Cooper, Hassie

doi:10.1097/ta.0b013e31821e0c6e

Cited by 32 publications

(35 citation statements)

References 13 publications

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“…There was a higher proportion of non-postoperative surgical ICU admission (32.3% vs 21.5%, P ϭ .045) but a lower proportion of surgical ICU admission after elective surgery (32.3% vs 48.8%, P ϭ .01) in the re-intubation group compared with that in the no reintubation group. Subjects requiring re-intubation had higher APACHE II scores (median 17 [IQR [13][14][15][16][17][18][19][20][21][22] Among 593 subjects admitted to the surgical ICU after either elective or emergency surgery, there were 44 subjects (7.4%) who required re-intubation (Table 1). When compared with subjects without re-intubation, those who required re-intubation had more frequent vascular site of surgery (29.5% vs 15.8%, P ϭ .02), more frequent American Society of Anesthesiologists physical status of Ն3 (92.3% vs 79.1%, P ϭ .01), and a higher score for prediction of postoperative respiratory complications (median 7 [IQR 5-8] vs 5 [3][4][5][6][7], P Ͻ .001).…”

Section: Study Cohort and Patients' Characteristicsmentioning

confidence: 99%

“…Of these 90 subjects, 26 (28.9%) required re-intubation. Subjects who required re-intubation following an NIV attempt, when compared with those who did not require re-intubation, had a higher rate of tracheostomy (61.5% vs 4.7%, P Ͻ .001), longer surgical ICU LOS (median 18 d vs 8 [5][6][7][8][9][10][11][12][13][14][15] d, P Ͻ .001), longer hospital LOS (30 d vs 18, 11-37 d, P ϭ .002), and a trend toward higher mortality (26.9% vs 14.1%, P ϭ .22). Among 65 re-intubated subjects, the median time (IRQ) to re-intubation was 21.3 (7.3-43.0) h after extubation.…”

Section: Predictors For Re-intubation and Prediction Scoresmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Re-intubation in nonsurgical critically ill patients is associated with increased mortality 5,9,13,14,[16][17][18]20 and morbidity, including prolonged mechanical ventilation support, 9,14 ventilator-associated pneumonia, 13,14,21 organ failure, 13,14 and prolonged length of stay (LOS). 5,9,[14][15][16][17] The most common reason for re-intubation reported is respiratory distress due to either primary respiratory failure or secondary causes, such as congestive heart failure, hemodynamic in-stability, airway obstruction from postextubation stridor or airway edema, inability to clear airway secretions, or altered mental status. 6,7,11,[13][14][15][16][17]19,20,22 In cri...…”

Section: Introductionmentioning

confidence: 99%

“…5,9,[14][15][16][17] The most common reason for re-intubation reported is respiratory distress due to either primary respiratory failure or secondary causes, such as congestive heart failure, hemodynamic in-stability, airway obstruction from postextubation stridor or airway edema, inability to clear airway secretions, or altered mental status. 6,7,11,[13][14][15][16][17]19,20,22 In critically ill patients, some predisposing factors for re-intubation have been proposed in the literature. Acquired muscle weakness is associated with aspiration, 23 prolonged weaning from mechanical ventilation, and weaning failure.…”

Section: Introductionmentioning

confidence: 99%

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Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

et al. 2015

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BACKGROUND: Re-intubation is associated with high morbidity and mortality. There is limited information regarding the risk factors that predispose patients admitted to the surgical ICU to re-intubation. We hypothesized that preoperative comorbidities, acquired muscular weakness, and renal dysfunction would be predictors of re-intubation in the surgical ICU population. METHODS: This was a prospective observational study in 2 surgical ICUs of a large tertiary hospital. All patients who were extubated during their surgical ICU stay were included. Demographic and clinical data were collected before and after extubation. The primary outcome was re-intubation within 72 h. Using multivariate logistic regression analysis, independent risk factors of re-intubation were determined, and a prediction score was developed. RESULTS: Between December 1, 2012, and January 31, 2014, we included 764 consecutive subjects. Of these, 65 subjects (8.5%) required re-intubation. Independent risk factors of re-intubation were blood urea nitrogen level of >8.2 mmol/L (odds ratio [OR] 3.66, 95% CI 1.97-6.80), hemoglobin level of <75 g/L (OR 2.10, 95% CI 1.23-3.61), and muscle strength of <3 (OR 2.03, 95% CI 1.16 -3.55). The presence of all 3 risk factors was associated with an estimated probability for re-intubation of 26.8%. CONCLUSIONS: In noncardiac surgery, surgical ICU subjects, elevated blood urea nitrogen level, low hemoglobin level, and muscle weakness were identified as independent risk factors for re-intubation. The presence of these risk factors can potentially aid clinicians in making informed decisions regarding optimal airway management in patients considered for an extubation attempt. (ClinicalTrials.gov registration NCT01967056.)

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Section: Study Cohort and Patients' Characteristicsmentioning

confidence: 99%

Section: Predictors For Re-intubation and Prediction Scoresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

et al. 2015

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“…This rate of failure to wean is higher than the 6% reported for mechanical ventilation secondary to trauma. 20 Here, we investigate whether RBC AChE activity within the first 24 h after presentation can identify patients who require longer periods of ventilation and whether the RBC AChE level at weaning can differentiate which patient is ready to be weaned from a mechanical ventilator. To the best of our knowledge, this is the first study to clinically evaluate the utility of RBC AChE measurement in patients requiring mechanical ventilation after organophosphate poisoning.…”

Section: Subjectsmentioning

confidence: 99%

Utility of Red Blood Cell Acetylcholinesterase Measurement in Mechanically Ventilated Subjects After Organophosphate Poisoning

Moon

Chun

2014

Respir Care

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BACKGROUND: Many patients with organophosphate poisoning require mechanical ventilation. Muscle acetylcholinesterase (AChE) activity determines the impairment of muscle force generation, and red blood cell (RBC) AChE has been regarded as a surrogate for muscle AChE in organophosphate poisoning. Therefore, this study was conducted to investigate whether RBC AChE at presentation can predict the duration of mechanical ventilatory support and whether RBC AChE at weaning can predict weaning trial outcomes in patients on mechanical ventilation for organophosphate poisoning. METHODS: This retrospective observational case series identified 74 patients with a history of mechanical ventilation secondary to organophosphate poisoning and whose RBC AChE levels were available at presentation to the emergency department, at 24 h of presentation, or at weaning. Data were collected for plasma cholinesterase assay results, weaning outcome, duration of mechanical ventilation, and details of patient management (including ICU stay and amount of atropine and pralidoxime administered). RESULTS: RBC AChE activity levels at presentation and at 24 h of presentation had a negative correlation with duration of mechanical ventilation in subjects who ingested dimethyl organophosphate, but this correlation was not observed for those who had ingested diethyl or unclassified organophosphate. The optimal cutoff value of RBC AChE activity at presentation for predicting mechanical ventilation for < 7 d was 1,330 U/L in subjects intoxicated with dimethyl organophosphate. However, there was no difference in RBC AChE activity at the time of weaning trial between successful and failed weaning events, regardless of the chemical formulation of organophosphate. CONCLUSIONS: We conclude that RBC AChE activity within 24 h of presentation can help predict the duration of mechanical ventilation for dimethyl organophosphate intoxication; however, RBC AChE activity at the time of weaning trial may not be a suitable parameter for predicting a patient's ability to be weaned from mechanical ventilation.

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Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients

Hernández

Vaquero

Colinas

et al. 2016

JAMA

491

435

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IMPORTANCE High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Among the advantages of high-flow oxygen therapy are comfort, availability, lower costs, and additional physiopathological mechanisms.OBJECTIVE To test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation. DESIGN, SETTING, AND PARTICIPANTSMulticenter randomized clinical trial in 3 intensive care units in Spain (September 2012-October 2014) including critically ill patients ready for planned extubation with at least 1 of the following high-risk factors for reintubation: older than 65 years; Acute Physiology and Chronic Health Evaluation II score higher than 12 points on extubation day; body mass index higher than 30; inadequate secretions management; difficult or prolonged weaning; more than 1 comorbidity; heart failure as primary indication for mechanical ventilation; moderate to severe chronic obstructive pulmonary disease; airway patency problems; or prolonged mechanical ventilation. INTERVENTIONSPatients were randomized to undergo either high-flow conditioned oxygen therapy or NIV for 24 hours after extubation. MAIN OUTCOMES AND MEASURES Primary outcomes were reintubation and postextubation respiratory failure within 72 hours. Noninferiority margin was 10 percentage points. Secondary outcomes included respiratory infection, sepsis, and multiple organ failure, length of stay and mortality; adverse events; and time to reintubation. RESULTS Of 604 patients (mean age, 65 [SD, 16] years; 388 [64%] men), 314 received NIV and 290 high-flow oxygen. Sixty-six patients (22.8%) in the high-flow group vs 60 (19.1%) in the NIV group were reintubated (absolute difference, −3.7%; 95% CI, −9.1% to ϱ); 78 patients (26.9%) in the high-flow group vs 125 (39.8%) in the NIV group experienced postextubation respiratory failure (risk difference, 12.9%; 95% CI, 6.6% to ϱ). Median time to reintubation did not significantly differ: 26.5 hours (IQR, 14-39 hours) in the high-flow group vs 21.5 hours (IQR, 10-47 hours) in the NIV group (absolute difference, −5 hours; 95% CI, −34 to 24 hours). Median postrandomization ICU length of stay was lower in the high-flow group, 3 days (IQR, 2-7) vs 4 days (IQR, 2-9; P=.048). Other secondary outcomes were similar in the 2 groups. Adverse effects requiring withdrawal of the therapy were observed in none of patients in the high-flow group vs 42.9% patients in the NIV group (P < .001).CONCLUSIONS AND RELEVANCE Among high-risk adults who have undergone extubation, high-flow conditioned oxygen therapy was not inferior to NIV for preventing reintubation and postextubation respiratory failure. High-flow conditioned oxygen therapy may offer advantages for these patients.

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Risk Factors Associated With Early Reintubation in Trauma Patients: A Prospective Observational Study

Cited by 32 publications

References 13 publications

Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

Utility of Red Blood Cell Acetylcholinesterase Measurement in Mechanically Ventilated Subjects After Organophosphate Poisoning

Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients

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