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Case-control study of failed extubation
Critical Care volume 16, Article number: P128 (2012)
Failed extubation (FE), defined as reintubation within 48 hours of planned extubation (PE), is common. The literature suggests that FE complicates 10 to 20% of PE. The consequences of FE have not been well described, nor have its risk factors.
We performed a retrospective study of prospectively collected data involving 2,012 consecutive patients undergoing mechanical ventilation (MV) in a 16-bed university-affiliated hospital between 1 October 2005 and 31 August 2011. Eighty-five patients with FE were matched 1:3 with successfully extubated patients (SE) using diagnostic category, age, Acute Physiology Score (APS) and duration of ventilation (DOV) before PE as matching criteria.
Patients undergoing MV included 1,209 (60.1%) with SE; 224 (11.1%) died during ventilation (without prior FE); 206 (10.2%) were extubated to withdraw support; 180 (8.9%) were transferred from the ICU while ventilated; 81 (4.0%) were liberated from MV after tracheostomy; 85 (6.6%) failed PE. APS scores were higher (53 (42 to 69) vs. 43 (32 to 60), P < 0.0001) and DOV before PE longer (1.8 (0.8 to 4.4) vs. 0.9 (0.4 to 2.6), P = 0.0001) in FE than in SE. There was 100% concordance of diagnostic category and no statistically significant differences between the groups in regards to age, APS and DOV before PE. Table 1 illustrates the results of the case-control analysis. In addition, FE had more days in the hospital after ICU discharge than did SE: 11 (4 to 24) versus 5 (2 to 9), P < 0.0001.
FE is associated with increased ICU and hospital LOS, increased risk of VAP and increased mortality. Efforts to prospectively identify patients at risk for FE may reduce its incidence and improve outcomes.
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Krinsley, J., Reddy, P. & Iqbal, A. Case-control study of failed extubation. Crit Care 16, P128 (2012). https://doi.org/10.1186/cc10735
- Public Health
- Retrospective Study
- Mechanical Ventilation
- Emergency Medicine
- Diagnostic Category