title: Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU.
abstract: BACKGROUND
  Re-intubation is associated with high morbidity and mortality. There is limited information regarding the risk factors that predispose patients admitted to the surgical ICU to re-intubation. We hypothesized that preoperative comorbidities, acquired muscular weakness, and renal dysfunction would be predictors of re-intubation in the surgical ICU population.
  
  
  METHODS
  This was a prospective observational study in 2 surgical ICUs of a large tertiary hospital. All patients who were extubated during their surgical ICU stay were included. Demographic and clinical data were collected before and after extubation. The primary outcome was re-intubation within 72 h. Using multivariate logistic regression analysis, independent risk factors of re-intubation were determined, and a prediction score was developed.
  
  
  RESULTS
  Between December 1, 2012, and January 31, 2014, we included 764 consecutive subjects. Of these, 65 subjects (8.5%) required re-intubation. Independent risk factors of re-intubation were blood urea nitrogen level of >8.2 mmol/L (odds ratio [OR] 3.66, 95% CI 1.97-6.80), hemoglobin level of <75 g/L (OR 2.10, 95% CI 1.23-3.61), and muscle strength of ≤3 (OR 2.03, 95% CI 1.16-3.55). The presence of all 3 risk factors was associated with an estimated probability for re-intubation of 26.8%.
  
  
  CONCLUSIONS
  In noncardiac surgery, surgical ICU subjects, elevated blood urea nitrogen level, low hemoglobin level, and muscle weakness were identified as independent risk factors for re-intubation. The presence of these risk factors can potentially aid clinicians in making informed decisions regarding optimal airway management in patients considered for an extubation attempt. (ClinicalTrials.gov registration NCT01967056.).
authors.affiliation: Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Annop
authors.initials: A
authors.lastname: Piriyapatsom
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Williams
authors.affiliation: Department of Physical and Occupational Therapy, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
authors.forename: Karen
authors.initials: K
authors.lastname: Waak
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine.
authors.forename: Karim S
authors.initials: KS
authors.lastname: Ladha
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine.
authors.forename: Matthias
authors.initials: M
authors.lastname: Eikermann
authors.affiliation: Department of Anesthesiology, University of California San Diego, San Diego, California. uschmidt@ucsd.edu.
authors.forename: Ulrich H
authors.initials: UH
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D060666:Airway Extubation / Q000009:adverse effects*; D001806:Blood Urea Nitrogen; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053580:Muscle Strength; D011446:Prospective Studies; D012044:Regression Analysis; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D017211:Treatment Failure; D015300:Ventilator Weaning
chemical_list: D006454:Hemoglobins
keywords: critically ill; prediction score; re-intubation; risk factors; surgical