Occurrence and complications of tracheal reintubation in critically ill adults.
BACKGROUND
Timing and preparation for tracheal extubation are as critical as the initial intubation. There are limited data on specific strategies for a planned extubation. The extent to which the difficult airway at reintubation contributes to patient morbidity is unknown. The aim  of the present study was to describe the occurrence and complications of failed extubation and associated risk factors, and to estimate the mortality and morbidity associated with reintubation attempts.


METHODS
Cohort study of 2,007 critically ill adult patients admitted to the ICU with an  ETT. Patients were classified in 2 groups, based on the requirement for reintubation: "never reintubated" versus "≥ 1 reintubations." Baseline characteristics, ICU and hospital stay, hospital mortality, and in-patient costs were compared between patients successfully  extubated and those with reintubation outside the operating room, using regression techniques. Reasons, airway management techniques, and complications of intubation and reintubation were summarized descriptively.


RESULTS
376 patients (19%) required reintubation, and 230 (11%) were reintubated  within 48 hours, primarily due to respiratory failure. Patients requiring reintubation were older, more likely to be male, and had higher admission severity score. Difficult intubation and complications were similar for initial and subsequent intubation. Reintubation was associated with a  5-fold increase in the relative odds of death (adjusted odds ratio 5.86, 95% CI 3.87-8.89, P < .01), and a 2-fold increase in median ICU and hospital stay, and institutional costs. Difficult airway at reintubation was associated with higher mortality (adjusted odds ratio 2.23,  95% CI 1.01-4.93, P = .05).


CONCLUSIONS
Nearly 20% of critically ill patients required out of operating room reintubation. Reintubation was associated with higher mortality, stay, and cost. Moreover, a difficult airway at reintubation was associated with higher mortality.
Department of Medicine, Saint Joseph Hospital, Phoenix, Arizona, USA.
Nithya
N
Menon
Aaron M
AM
Joffe
Steven
S
Deem
N David
ND
Yanez
Andreas
A
Grabinsky
Armagan Hc
AH
Dagal
Stephen
S
Daniel
Miriam M
MM
Treggiari
D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000401:mortality / Q000628:therapy; D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000191:economics / Q000401:mortality*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy