title: Prognosis and patterns of failure for the extubation of patients who remain intubated after head and neck surgery.
abstract: OBJECTIVE
  This study aimed to analyze the rate of failure, patterns of failure, and prognostic factors for patients who remain intubated after head and neck surgery and then undergo delayed extubation.
  
  
  METHODS
  Retrospective chart review of all otolaryngology patients who remained intubated after head and neck surgery and then underwent delayed extubation between 2006 and 2013. The incidence and patterns of extubation failure were analyzed. Univariable logistic regression analysis was performed to identify risk factors for postextubation failure.
  
  
  RESULTS
  Fifteen of the 129 patients (12%) who remained intubated after head and neck surgery and underwent delayed extubation subsequently failed and required either repeat intubation or an emergency surgical airway. The most common reasons for failure were hemorrhage (47%) and upper airway edema (33%). Failure typically occurred within 6 hours of extubation. Twenty-seven percent of the patients who failed extubation (4/15) required an emergency surgical airway. On univariable logistic regression analysis, ligation of a major neck vessel predicted extubation failure (odds ratio=5.20; 95% confidence interval, 1.48-18.23).
  
  
  CONCLUSIONS
  Postextubation failure in carefully selected patients undergoing delayed extubation after head and neck surgery is infrequent and most commonly due to postoperative bleeding. Prospective data are required to facilitate safe and quality care for these patients.
authors.affiliation: Washington University in St Louis School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St Louis, Missouri, USA.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Graboyes
authors.affiliation: Washington University in St Louis School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St Louis, Missouri, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Bradley
authors.affiliation: Washington University in St Louis School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St Louis, Missouri, USA.
authors.forename: Dorina
authors.initials: D
authors.lastname: Kallogjeri
authors.affiliation: Washington University in St Louis School of Medicine, Department of Anesthesiology, St Louis, Missouri, USA.
authors.forename: Laura F
authors.initials: LF
authors.lastname: Cavallone
authors.affiliation: Washington University in St Louis School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St Louis, Missouri, USA nussenbaumb@ent.wustl.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Nussenbaum
mesh_terms: D060666:Airway Extubation; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology
keywords: airway management; cricothyrotomy; difficult airway; extubation; hematoma; tracheotomy