title: Assessing the need for reintubation: a prospective evaluation of unplanned endotracheal extubation.
abstract: OBJECTIVE
  Unplanned endotracheal extubation (UEE) is a common complication in medical intensive care units but very little data about UEE in surgical populations are available. Our hypothesis is that the surgical intensive care unit (SICU) population requires reintubation less frequently compared with the medical intensive care unit population. We prospectively gathered data on patients in a SICU in an attempt to identify the incidence of UEE and to study the need for reintubation after UEE.
  
  
  METHODS
  During an 18-month period, we prospectively identified SICU patients from a quality improvement database who required ventilatory support. All patients who self-extubated were included in the study.
  
  
  RESULTS
  Fifty-eight of 1,178 intubated patients experienced unplanned extubation 61 times during the 18-month period. A total of 22 patients (36%) required reintubation, whereas 39 patients (64%) did not. Thirty-three patients self-extubated while being actively weaned from ventilatory support. Of these, only 5 patients (15%) required reintubation and 28 patients (85%) did not (p < 0.01).
  
  
  CONCLUSIONS
  A total of 85% of patients who self-extubate during the weaning process did not require reintubation in our study. Those who have an FiO2 >50%, a lower PaO2/FiO2 ratio, had UEE occur by accident, or were not being weaned when UEE occurred required reintubation more frequently. These data suggest that some of our SICU patients are intubated longer than necessary, which may translate into more ventilator related complications, longer ICU stays and increased cost.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA.
authors.forename: T
authors.initials: T
authors.lastname: Razek
authors.forename: V
authors.initials: V
authors.lastname: Gracias
authors.forename: D
authors.initials: D
authors.lastname: Sullivan
authors.forename: C
authors.initials: C
authors.lastname: Braxton
authors.forename: R
authors.initials: R
authors.lastname: Gandhi
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.forename: J
authors.initials: J
authors.lastname: Malcynski
authors.forename: H L
authors.initials: HL
authors.lastname: Anderson
authors.forename: P M
authors.initials: PM
authors.lastname: Reilly
authors.forename: C W
authors.initials: CW
authors.lastname: Schwab
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012121:Respiration, Artificial; D019233:Retreatment; D016312:Treatment Refusal; D015300:Ventilator Weaning