title: Unplanned intubation: when and why does this deadly complication occur?
abstract: BACKGROUND
  Risk factors for unplanned intubation have been delineated, but details regarding when and why reintubations occur as well as strategies for prevention have not been defined.
  
  
  METHODS
  Over a 2-year period, 104 of 3,141 patients (3.3%) monitored via the American College of Surgeons-National Surgical Quality Improvement Program required unplanned intubation. These patients were compared to those who remained extubated and were characterized by (1) the operation performed; (2) the postoperative day when reintubation occurred; and (3) the underlying causes.
  
  
  RESULTS
  Patients who required reintubation were significantly older (65.8 years) and were more likely to be male (55%) and to have several comorbidities, weight loss (16%), dependency (14%), or sepsis (9%). The operations complicated most commonly by unplanned intubation were gastrectomy (13%), nephrectomy (10%), colectomy (9%), pancreatectomy (8%), hepatectomy (7%), and enterectomy (6%). The most common causes and median postoperative days were sepsis (33%, day 8) and aspiration/pneumonia (31%, day 4). Sepsis was due most commonly to an abdominal or pelvic abscess (74%), which was frequently not recognized despite an inflammatory response. Aspiration occurred most commonly after upper abdominal operations (78%) despite signs of diminished bowel function.
  
  
  CONCLUSIONS
  Postoperative sepsis and aspiration/pneumonia account for two thirds of unplanned intubations. Opportunities for management of patients exist for the prevention of this deadly complication.
authors.affiliation: Department of Surgery, Indiana University, Indianapolis, IN, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Milgrom
authors.forename: Victor C
authors.initials: VC
authors.lastname: Njoku
authors.forename: Alison M
authors.initials: AM
authors.lastname: Fecher
authors.forename: E Molly
authors.initials: EM
authors.lastname: Kilbane
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects; D011015:Pneumonia, Aspiration / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D018805:Sepsis / Q000209:etiology; D013997:Time Factors