title: Factors Associated with Reintubation in an Intensive Care Unit: A Prospective Observational Study.
abstract: OBJECTIVE
  The objective of the study was to determine the incidence of failed extubations in our Intensive Care Unit (ICU) and identify associated clinical factors.
  
  
  METHODS
  A prospective observational study of mechanically ventilated patients who underwent extubation attempts in our (predominantly surgical) ICU was undertaken from July 2012 to August 2013. The primary endpoint was the need for nonelective reintubation within 72 h of extubation. Clinical data of the reintubated patients were compared with those who were successfully extubated to identify factors associated with reintubation.
  
  
  RESULTS
  Five hundred and eight extubation attempts were documented, 38 (7.5%) of which were unsuccessful. On multivariate analysis, the following clinical factors were found to be associated with an increased risk of failed extubation: unplanned extubations (adjusted odds ratio [OR] 5.8), the use of noninvasive ventilation (NIV) postextubation (adjusted OR 3.2), and sepsis (adjusted OR 2.9). Patient demographic factors, other premorbid and comorbid medical conditions, and differences of laboratory parameters did not appear to significantly influence reintubation rates in our study.
  
  
  CONCLUSIONS
  Our study has demonstrated a relatively low reintubation rate, likely due to inclusion of elective admissions/intubations in our patient population. Unplanned extubations, the use of NIV postextubation, and sepsis were associated with increased reintubation risk, reinforcing the need for increased vigilance in this subgroup of patients after extubation.
authors.affiliation: Department of Anesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
authors.forename: Eric Shih
authors.initials: ES
authors.lastname: Hsiung Lee
authors.affiliation: Department of Anesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
authors.forename: Danny Tse
authors.initials: DT
authors.lastname: Jiann Lim
authors.affiliation: Department of Anesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
authors.forename: Juvel Mabao
authors.initials: JM
authors.lastname: Taculod
authors.affiliation: Department of Anesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
authors.forename: Juliet Tolentino
authors.initials: JT
authors.lastname: Sahagun
authors.affiliation: Department of Anesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
authors.forename: Joerie Pasive
authors.initials: JP
authors.lastname: Otero
authors.affiliation: Department of Anesthesia, Singapore General Hospital, Outram Road, Singapore.
authors.forename: Kaimin
authors.initials: K
authors.lastname: Teo
authors.affiliation: Department of Anesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
authors.forename: Will Ne-Hooi
authors.initials: WN
authors.lastname: Loh
authors.affiliation: Department of Anesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
authors.forename: Addy Yong
authors.initials: AY
authors.lastname: Hui Tan
keywords: Extubation failure; mechanical ventilation; risk factors