Can extubation failure be related to high unit activity?

Introduction

Extubation failure has become an important quality indicator. The aim of our study was to ascertain whether extubation failure was related to unit activity; that is, whether it was more frequent on days of greater unit activity.

Methods

We retrospectively analysed 520 consecutive admissions to our seven-bed ICU over an 18-month period. We defined extubation failure as the need for reintubation within 24 hours. Bed occupancy was used as a surrogate marker of unit activity. Bed occupancy was based upon the number of hours patients were nursed in the ICU each day and was summed and expressed as a percentage of the maximum available (24 × 7). Data were collected from our national audit database and analysed using SPSS software.

Results

We studied 520 intubated patients over an 18-month period after excluding children, tracheostomised patients and patients who were receiving end-of-life care. Sixty-five patients (12.5%) were reintubated within the 24 hours. Bed occupancy was not different in the extubation success group as compared with the failure group (70.6 CI ± 1.75 vs. 72.9 CI ± 4.9; P = 0.37). The two groups were similar in terms of their severity of illness; that is, APACHE II scores. Length of stay was increased in the extubation failure group. There was no correlation between bed occupancy and extubation failure using the Pearson correlation coefficient (R = 0.05; P = 0.68). See Table 1 and Figure 1.

Table 1

Figure 1

Scatterplot of reintubation rates versus bed occupancy.

Conclusions

We could not demonstrate any correlation between high unit activity and reintubation rates.