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Epidemiology - Outcomes

Research Snapshot Theater: Epidemiology - Outcomes, Adult II

(326) Effect of Reintubation on Outcomes in the Surgical ICU

Tuesday, February 25, 2025
8:45am – 9:45am Eastern Time
Location: Connections Central - RST 02
Introduction: Reintubation (RI) is associated with longer hospitalization, pneumonia, and death. While RI rates of 10-20% are accepted, identifying risk factors for RI can allow for preventative strategies to be implemented. The goal of this study is to better understand RI rate, risk factors, and patient outcomes associated with RI within a surgical ICU (SICU).

Methods: This study is a retrospective chart review for patients on mechanical ventilation (MV) in the SICU between 1/2019-12/2020. We excluded patients < 18 years old, terminally extubated with no previous RI, self-extubation, death before extubation, and tracheostomy before extubation. RI was defined as unplanned intubation within 96 hours of extubation. Successfully extubated patients were compared to the RI patients.

Results: RI occurred in 8.4% (70/837) of included patients. 467 patients (35.81%) were excluded due to < 18 years old (0.46%), terminal extubation (14.26%), self-extubation (3.07%), death before extubation (3.37%), tracheostomy before intubation (6.06%) or before extubation (8.51%), and hospital transfer (0.08%).
RI was associated with older age (60.5 vs 57 y, p=0.048), previous stroke (28.6 vs 9.4%, p< 0.0001), atrial fibrillation (34.3 vs 15.7%, p< 0.0001), spinal cord injury (12.9 vs 5.7%, p=0.019), rib fracture (32.9 vs 16.4%, p< 0.001), admitting service (p=0.017), duration of MV before extubation (59 vs 18 h, p< 0.0001), and fluid balance at extubation (5141 vs 3387 mL, p=0.0038). Patients with RI had significantly higher total MV hours (247 vs 18 h), tracheostomy placement (54.3 vs 1.7%), VAP (22.9 vs 1.6%), ICU stay (14 vs 2 d), hospital stay (24 vs 10 d), and mortality (25.7 vs 0.9%).

Conclusions: We identified several risk factors for RI when compared to successfully extubated patients. While our SICU RI rate is lower than 10%, the significant morbidity and increased mortality associated with RI appears to justify the development of preventative strategies to decrease RI in the high-risk population.