Trauma patients can be safely extubated in the emergency department.
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.
Weingart
Scott D
SD
Division of Emergency Critical Care, Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA.
Menaker
Jay
J
Truong
Hanh
H
Bochicchio
Kelly
K
Scalea
Thomas M
TM
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