title: Trauma patients can be safely extubated in the emergency department.
abstract: BACKGROUND
  Many trauma patients are intubated for conditions that fully resolve during their emergency department (ED) stay. Often, these patients remain intubated until after they leave the ED.
  
  
  OBJECTIVE
  The objective of this study was to examine the prognosis of patients extubated in the ED.
  
  
  METHODS
  Data from the records of adult trauma patients who were intubated and then extubated in the ED at a single trauma referral center were prospectively collected for a quality initiative. Two trained abstractors retrospectively recorded these data as well as additional information from the trauma registry and patient charts. The primary outcome was the need for unplanned reintubation during hospitalization. Additional outcomes were disposition and complications from the extubation.
  
  
  RESULTS
  There were 50 eligible patients identified and included in the study. Reasons for the intubation included combative behavior or decreased mental status before computed axial tomography (CT) scan in 24 patients (48%), sedation before the performance of a painful procedure in 18 patients (36%), and seizures before CT scan in 3 patients (6%). None of the patients (0%; 95% confidence interval 0-6%) required unplanned reintubation. Eight (16%) of the patients were able to be discharged from the ED before admission.
  
  
  CONCLUSIONS
  Although our findings must be verified in larger, controlled studies, it may be safe to extubate patients in the ED, if the condition necessitating intubation has fully resolved. This practice may reduce admission rates and limit the need for intensive care unit beds for the patients who are admitted.
authors.affiliation: Division of Emergency Critical Care, Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Weingart
authors.forename: Jay
authors.initials: J
authors.lastname: Menaker
authors.forename: Hanh
authors.initials: H
authors.lastname: Truong
authors.forename: Kelly
authors.initials: K
authors.lastname: Bochicchio
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020878:Device Removal; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult