title: Cumulative Probability and Time to Reintubation in U.S. ICUs.
abstract: OBJECTIVE
  Reintubation after liberation from mechanical ventilation is viewed as an adverse event in ICUs. We sought to describe the frequency of reintubations across U.S. ICUs and to propose a standard, appropriate time cutoff for reporting of reintubation events.
  
  
  METHODS
  We conducted a cohort study using data from the Project IMPACT database of 185 diverse ICUs in the United States.
  
  
  METHODS
  We included patients who received mechanical ventilation and excluded patients who received a tracheostomy, had a do-not-resuscitate order placed, or died prior to first extubation.
  
  
  RESULTS
  We assessed the percentage of patients extubated who were reintubated; the cumulative probability of reintubation, with death and do-not-resuscitate orders after extubation modeled as competing risks, and time to reintubation. Among 98,367 patients who received mechanical ventilation without death or tracheostomy prior to extubation, 9,907 (10.1%) were reintubated, with a cumulative probability of 10.0%. Median time to reintubation was 15 hours (interquartile range, 2-45 hr). Of patients who required reintubation in the ICU, 90% did so within the first 96 hours after initial extubation; this was consistent across various patient subtypes (89.3% for electives surgical patients up to 94.8% for trauma patients) and ICU subtypes (88.6% for cardiothoracic ICUs to 93.5% for medical ICUs).
  
  
  CONCLUSIONS
  The reintubation rate for ICU patients liberated from mechanical ventilation in U.S. ICUs is approximately 10%. We propose a time cutoff of 96 hours for reintubation definitions and benchmarking efforts, as it captures 90% of ICU reintubation events. Reintubation rates can be reported as simple percentages, without regard for deaths or changes in goals of care that might occur.
authors.affiliation: 1Department of Anesthesiology, Columbia University, New York, NY. 2Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY. 3Department of Epidemiology, Columbia University, New York, NY. 4Prescient Healthcare Consulting, Charlottesville, VA. 5Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 6Department of Anesthesia and Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Miltiades
authors.forename: Hayley B
authors.initials: HB
authors.lastname: Gershengorn
authors.forename: May
authors.initials: M
authors.lastname: Hua
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Kramer
authors.forename: Guohua
authors.initials: G
authors.lastname: Li
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
mesh_terms: D018806:APACHE; D000368:Aged; D015331:Cohort Studies; D005260:Female; 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; D011336:Probability; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D012307:Risk Factors; D013997:Time Factors; D014481:United States; D015300:Ventilator Weaning / Q000706:statistics & numerical data