Fernando Frutos-Vivar1, Andrés Esteban2, Carlos Apezteguia3, Marco González4, Yaseen Arabi5, Marcos I Restrepo6, Federico Gordo7, Cristina Santos8, Jamal A Alhashemi9, Fernando Pérez10, Oscar Peñuelas1, Antonio Anzueto6. 1. Hospital Universitario de Getafe and CIBER Enfermedades Respiratorias, Madrid, Spain. 2. Hospital Universitario de Getafe and CIBER Enfermedades Respiratorias, Madrid, Spain. Electronic address: aesteban@ucigetafe.com. 3. Hospital Profesor A.Posadas, Buenos Aires, Argentina. 4. Clinica Medellín and Universidad Pontificia Bolivariana, Medellín, Colombia. 5. King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 6. South Texas Veterans Health Care System Audie L. Murphy Division and University of Texas Health Science Center, San Antonio, TX. 7. Hospital del Henares, Madrid, Spain. 8. Hospital de Clínicas de Montevideo, Uruguay. 9. King Abdulaziz University, Jeddah, Saudi Arabia. 10. Hospital de Clínicas de Caracas, Venezuela.
Abstract
PURPOSE: The main objective of study was to evaluate the outcome of patients who require reintubation after elective extubation. MATERIALS AND METHODS: This is an observational, prospective cohort study including mechanically ventilated patients who passed successfully a spontaneous breathing trial. Patients were observed for 48 hours after extubation. During this time, reintubation or use of noninvasive positive pressure ventilation was considered as a failure. Reintubated patients were followed after the reintubation to register complications and outcome. RESULTS: A total of 1,152 extubated patients were included in the analysis. Three hundred thirty-six patients (29%) met the criteria for extubation failure. Extubation failure was independently associated with mortality (odds ratio, 3.29; 95% confidence interval, 2.19-4.93). One hundred eighty patients (16% of overall cohort) required reintubation within 48 hours after extubation. Median time from extubation to reintubation was 13 hours (interquartile range, 6-24 hours). Reintubation was independently associated with mortality (odds ratio, 5.18; 95% confidence interval, 3.38-7.94; P < .001). Higher mortality of reintubated patients was due to the development of complications after the reintubation. CONCLUSIONS: In a large cohort of scheduled extubated patients, one third of patients developed extubation failure, of whom half needed reintubation. Reintubation was associated with increased mortality due to the development of new complications after reintubation.
PURPOSE: The main objective of study was to evaluate the outcome of patients who require reintubation after elective extubation. MATERIALS AND METHODS: This is an observational, prospective cohort study including mechanically ventilated patients who passed successfully a spontaneous breathing trial. Patients were observed for 48 hours after extubation. During this time, reintubation or use of noninvasive positive pressure ventilation was considered as a failure. Reintubated patients were followed after the reintubation to register complications and outcome. RESULTS: A total of 1,152 extubated patients were included in the analysis. Three hundred thirty-six patients (29%) met the criteria for extubation failure. Extubation failure was independently associated with mortality (odds ratio, 3.29; 95% confidence interval, 2.19-4.93). One hundred eighty patients (16% of overall cohort) required reintubation within 48 hours after extubation. Median time from extubation to reintubation was 13 hours (interquartile range, 6-24 hours). Reintubation was independently associated with mortality (odds ratio, 5.18; 95% confidence interval, 3.38-7.94; P < .001). Higher mortality of reintubated patients was due to the development of complications after the reintubation. CONCLUSIONS: In a large cohort of scheduled extubated patients, one third of patients developed extubation failure, of whom half needed reintubation. Reintubation was associated with increased mortality due to the development of new complications after reintubation.
Authors: Andrea N Miltiades; Hayley B Gershengorn; May Hua; Andrew A Kramer; Guohua Li; Hannah Wunsch Journal: Crit Care Med Date: 2017-05 Impact factor: 7.598
Authors: M Mar Fernandez; Alejandro González-Castro; Monica Magret; M Teresa Bouza; Marcos Ibañez; Carolina García; Begoña Balerdi; Arantxa Mas; Vanesa Arauzo; José M Añón; Francisco Ruiz; José Ferreres; Roser Tomás; Marta Alabert; Ana Isabel Tizón; Susana Altaba; Noemi Llamas; Rafael Fernandez Journal: Intensive Care Med Date: 2017-09-22 Impact factor: 17.440
Authors: Nita Khandelwal; Christopher R Dale; David C Benkeser; Aaron M Joffe; Norbert David Yanez; Miriam M Treggiari Journal: J Cardiothorac Vasc Anesth Date: 2014-11-11 Impact factor: 2.628
Authors: Abdelrady S Ibrahim; Mohamed G Aly; Khaled A Abdel-Rahman; Mona A Mohamed; Mogedda M Mehany; Eman M Aziz Journal: Neurocrit Care Date: 2018-10 Impact factor: 3.210
Authors: Maximilian Hammer; Peter Santer; Maximilian S Schaefer; Friederike C Althoff; Karuna Wongtangman; Ulrich H Frey; Xinling Xu; Matthias Eikermann; Philipp Fassbender Journal: Br J Anaesth Date: 2020-12-17 Impact factor: 9.166