Christopher P Michetti1, Margaret M Griffen2, Erik J Teicher3, Jennifer L Rodriguez4, Hani Seoudi5, Chang Liu6, Elena Lita7, Anna Newcomb8. 1. Department of Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, United States. Electronic address: christopher.michetti@inova.org. 2. Department of Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, United States. Electronic address: margaret.griffen@inova.org. 3. Department of Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, United States. Electronic address: erik.teicher@inova.org. 4. Department of Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, United States. Electronic address: jennifer.rodriguez2@inova.org. 5. Department of Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, United States. Electronic address: hani.seoudi@inova.org. 6. Department of Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, United States. Electronic address: chang.liu@inova.org. 7. Department of Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, United States. Electronic address: elena.lita@inova.org. 8. Department of Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, United States. Electronic address: anna.newcomb@inova.org.
Abstract
BACKGROUND: A Form for Re-Intubation Evaluation by Nurses and Doctors (FRIEND) was used to prospectively collect pre-extubation data, to determine failure of extubation (FOE) risk. METHODS: FRIENDs, including airway, breathing, and neurologic variables, were completed before extubation on trauma & surgical patients in one ICU from 1/1/16 to 5/31/17. Those with failed vs. successful extubation were compared. We excluded those with tracheostomy, comfort measures, or death before extubation. RESULTS: There were 464 eligible extubations in 436 patients. Thirty five reintubations (7.9% FOE rate) occurred in 32 patients within 96 h of extubation. FOE patients had higher ICU days (6 d vs. 2 d), ventilator days (6 d vs. 2 d), and mortality (15.6% vs. 2.7%) [all p < 0.001] compared to those without FOE. Odds of FOE (OR [CI]) increased with age (1.03, [1, 1.06]), delirium (3, [1.16, 7.76]), moderate/copious secretions (3.95, [1.46, 10.66]), and enteral opioid use (4.23, [1.28, 14.02]). CONCLUSIONS: Several characteristics present at the time of extubation were risk factors for FOE in trauma and surgical patients. Patients with FOE had higher mortality.
BACKGROUND: A Form for Re-Intubation Evaluation by Nurses and Doctors (FRIEND) was used to prospectively collect pre-extubation data, to determine failure of extubation (FOE) risk. METHODS: FRIENDs, including airway, breathing, and neurologic variables, were completed before extubation on trauma & surgical patients in one ICU from 1/1/16 to 5/31/17. Those with failed vs. successful extubation were compared. We excluded those with tracheostomy, comfort measures, or death before extubation. RESULTS: There were 464 eligible extubations in 436 patients. Thirty five reintubations (7.9% FOE rate) occurred in 32 patients within 96 h of extubation. FOEpatients had higher ICU days (6 d vs. 2 d), ventilator days (6 d vs. 2 d), and mortality (15.6% vs. 2.7%) [all p < 0.001] compared to those without FOE. Odds of FOE (OR [CI]) increased with age (1.03, [1, 1.06]), delirium (3, [1.16, 7.76]), moderate/copious secretions (3.95, [1.46, 10.66]), and enteral opioid use (4.23, [1.28, 14.02]). CONCLUSIONS: Several characteristics present at the time of extubation were risk factors for FOE in trauma and surgical patients. Patients with FOE had higher mortality.