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Risk Factors for Reintubation in an Academic Medical Intensive Care Unit
Description
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A1139 - Risk Factors for Reintubation in an Academic Medical Intensive Care Unit
Author Block: J. D. Casey, T. W. Rice, M. W. Semler; Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States.
BACKGROUND:
Critically ill adults who are removed from invasive mechanical ventilation frequently experience reintubation. Reintubation increases the risk of nosocomial infections and independently predicts mortality. Post-extubation respiratory support with non-invasive ventilation or high flow nasal cannula may reduce the rate of reintubation. ACCP/ATS guidelines recommend prophylactic post-extubation noninvasive ventilation for patients at high risk of reintubation. The optimal method of identifying patients at high risk for reintubation, however, remains unclear.
METHODS:
In a retrospective analysis of 802 patients who received invasive mechanical ventilation for at least 12 hours in the medical intensive care unit of an academic medical center in the United States, we performed manual chart review to collect previously reported predictors of reintubation, including age, indication for intubation, APACHEII score, and duration of mechanical ventilation prior to extubation, as well as other baseline variables including gender, race, and body mass index. Receipt of post-extubation respiratory support was also recorded. Using characteristics available at the time of extubation, we developed a multivariable logistic regression model for the outcome of reintubation within 96 hours.
RESULTS:
Of 802 patients who received mechanical ventilation, 382 were excluded due to death prior to extubation, tracheostomy, transfer to another intensive care unit or facility, or the placement of a “Do Not Reintubate” order prior to extubation. Of the 420 patients included in the final analysis, 52 patients (12.3%) were reintubated within 96 hours. In multivariable analysis, none of the previously reported risk factors predicted reintubation. There was a significant difference in the utilization of prophylactic post-extubation respiratory support between patients who were reintubated within 96 hours (15.7%) and those who were not (7.3%) (p=0.043).
CONCLUSION:
In a moderately sized population of critically ill adults, previously reported risk factors failed to predict reintubation within 96 hours. Higher use of post-extubation respiratory support among patients who ultimately required reintubation suggests clinicians may be able to identify patients at higher risk of reintubation. In order to provide post-extubation respiratory support to patients at high risk of reintubation (as recommended in international guidelines), further research is needed to understand the contributors to reintubation and develop and validate predictive tools.
Author Block: J. D. Casey, T. W. Rice, M. W. Semler; Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States.
BACKGROUND:
Critically ill adults who are removed from invasive mechanical ventilation frequently experience reintubation. Reintubation increases the risk of nosocomial infections and independently predicts mortality. Post-extubation respiratory support with non-invasive ventilation or high flow nasal cannula may reduce the rate of reintubation. ACCP/ATS guidelines recommend prophylactic post-extubation noninvasive ventilation for patients at high risk of reintubation. The optimal method of identifying patients at high risk for reintubation, however, remains unclear.
METHODS:
In a retrospective analysis of 802 patients who received invasive mechanical ventilation for at least 12 hours in the medical intensive care unit of an academic medical center in the United States, we performed manual chart review to collect previously reported predictors of reintubation, including age, indication for intubation, APACHEII score, and duration of mechanical ventilation prior to extubation, as well as other baseline variables including gender, race, and body mass index. Receipt of post-extubation respiratory support was also recorded. Using characteristics available at the time of extubation, we developed a multivariable logistic regression model for the outcome of reintubation within 96 hours.
RESULTS:
Of 802 patients who received mechanical ventilation, 382 were excluded due to death prior to extubation, tracheostomy, transfer to another intensive care unit or facility, or the placement of a “Do Not Reintubate” order prior to extubation. Of the 420 patients included in the final analysis, 52 patients (12.3%) were reintubated within 96 hours. In multivariable analysis, none of the previously reported risk factors predicted reintubation. There was a significant difference in the utilization of prophylactic post-extubation respiratory support between patients who were reintubated within 96 hours (15.7%) and those who were not (7.3%) (p=0.043).
CONCLUSION:
In a moderately sized population of critically ill adults, previously reported risk factors failed to predict reintubation within 96 hours. Higher use of post-extubation respiratory support among patients who ultimately required reintubation suggests clinicians may be able to identify patients at higher risk of reintubation. In order to provide post-extubation respiratory support to patients at high risk of reintubation (as recommended in international guidelines), further research is needed to understand the contributors to reintubation and develop and validate predictive tools.
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