Daytime Versus Nighttime Extubations: A Comparison of Reintubation, Length of Stay, and Mortality.
OBJECTIVE
Despite studies regarding outcomes of day versus night medical care, consequences of nighttime extubations are unknown. It may be favorable to extubate patients off-hours, as soon as weaning parameters are met, since this could decrease complications and shorten length of stay (LOS). Conversely, nighttime extubation could be deleterious, as staffing varies during this time. We hypothesized that patients have similar reintubation rates, irrespective of extubation time.


METHODS
A retrospective cohort study performed at 2 hospitals within a tertiary academic medical center included all adult intensive care unit (ICU) patients extubated between July 01, 2009 and May 31, 2011. Those extubated due to withdrawal of support were excluded. The nighttime group included patients extubated between 7:00 pm and 6:59 am and the daytime group included patients extubated between 7:00 am and 6:59 pm.


RESULTS
Of 2240 extubated patients, 1555 were extubated during the day and 685 were extubated at night. Of these, 119 (7.7%) and 26 (3.8%), respectively, were reintubated in 24 hours with likelihood of reintubation significantly lower for nighttime than daytime after multivariable adjustment (odds ratio [OR] = 0.5, 95% confidence interval [CI] 0.3-0.9, P = .01), with a similar trend for reintubation within 72 hours (OR = 0.7, 95% CI = 0.5-1.0, P = .07). There was a trend toward decreased mortality for patients extubated at night (OR = 0.6, 95% CI = 0.3-1.0, P = .06). There was also a significantly lower LOS for patients extubated at night (P = .002). In a confirmatory frequency-matched analysis, there was no significant difference in reintubation proportion or mortality, but LOS was significantly less in those extubated at night.


CONCLUSIONS
Intensive care unit extubations at night did not have higher likelihood of reintubation, LOS, or mortality compared to those during the day. Since patients should be extubated as soon as they meet parameters in order to potentially decrease complications of mechanical ventilation, these data provide no support for delaying extubation until daytime.
Albert Einstein College of Medicine, Bronx, NY, USA brt9027@nyp.org.
Bryan R
BR
Tischenkel
Department of Medicine, Division of Critical Care Medicine, JB Langner Critical Care Service, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
Michelle N
MN
Gong
Department of Medicine, Division of Critical Care Medicine, JB Langner Critical Care Service, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
Ariel L
AL
Shiloh
Department of Medicine, Division of Critical Care Medicine, JB Langner Critical Care Service, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
Vincent C
VC
Pittignano
Albert Einstein College of Medicine, Bronx, NY, USA.
Yonatan G
YG
Keschner
Albert Einstein College of Medicine, Bronx, NY, USA.
Jesse A
JA
Glueck
Department of Epidemiology and Population Health, Division of Biostatistics, Albert Einstein College of Medicine, Bronx, NY, USA.
Hillel W
HW
Cohen
Department of Medicine, Division of Critical Care Medicine, JB Langner Critical Care Service, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
Lewis A
LA
Eisen
D000368:Aged; D060666:Airway Extubation / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015300:Ventilator Weaning / Q000379:methods
airway extubation; artificial; intensive care; outcome assessment (health care); respiration; respiratory insufficiency; ventilator weaning