title: Risk factors associated with early reintubation in trauma patients: a prospective observational study.
abstract: BACKGROUND
  After mechanical ventilation, extubation failure is associated with poor outcomes and prolonged hospital and intensive care unit (ICU) stays. We hypothesize that specific and unique risk factors exist for failed extubation in trauma patients. The purpose of this study was to identify the risk factors in trauma patients.
  
  
  METHODS
  We performed an 18-month (January 2008-June 2009) prospective, cohort study of all adult (8 years or older) trauma patients admitted to the ICU who required mechanical ventilation. Failure of extubation was defined as reintubation within 24 hours of extubation. Patients who failed extubation (failed group) were compared with those who were successfully extubated (successful group) to identify independent risk factors for failed extubation.
  
  
  RESULTS
  A total of 276 patients were 38 years old, 76% male, 84% sustained blunt trauma, with an mean Injury Severity Score = 21, Glasgow Coma Scale (GCS) score = 7, and systolic blood pressure = 125 mm Hg. Indications for initial intubation included airway (4%), breathing (13%), circulation (2%), and neurologic disability (81%). A total of 17 patients (6%) failed extubation and failures occurred a mean of 15 hours after extubation. Independent risk factors to fail extubation included spine fracture, airway intubation, GCS at extubation, and delirium tremens. Patients who failed extubation spent more days in the ICU (11 vs. 6, p = 0.006) and hospital (19 vs. 11, p = 0.002). Mortality was 6% (n = 1) in the failed group and 0.4% (n = 1) in the successful extubation group.
  
  
  CONCLUSIONS
  Independent risk factors for trauma patients to fail extubation include spine fracture, initial intubation for airway, GCS at extubation, and delirium tremens. Trauma patients with these four risk factors should be observed for 24 hours after extubation, because the mean time to failure was 15 hours. In addition, increased complications, extended need for mechanical ventilation, and prolonged ICU and hospital stays should be expected for trauma patients who fail extubation.
authors.affiliation: Department of Surgery, University Medical Center Brackenridge, Austin, TX, USA. cvrbrown@seton.org
authors.forename: Carlos V R
authors.initials: CV
authors.lastname: Brown
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Daigle
authors.forename: Kelli H
authors.initials: KH
authors.lastname: Foulkrod
authors.forename: Brandee
authors.initials: B
authors.lastname: Brouillette
authors.forename: Adam
authors.initials: A
authors.lastname: Clark
authors.forename: Clea
authors.initials: C
authors.lastname: Czysz
authors.forename: Marnie
authors.initials: M
authors.lastname: Martinez
authors.forename: Hassie
authors.initials: H
authors.lastname: Cooper
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000209:etiology; D019233:Retreatment / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors; D015599:Trauma Severity Indices; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology; D015300:Ventilator Weaning / Q000009:adverse effects* / Q000379:methods; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult