To examine medical outcomes associated with reintubation for extubation failure after
discontinuation of mechanical ventilation.
Prospective cohort study of consecutive intubated medical ICU patients who underwent
a trial of extubation at a tertiary-care teaching hospital. The failed extubation
group consisted of all patients reintubated within 72 h or within 7 days (if continuous
ICU care had been required) of extubation. All others were considered to be successfully
extubated. Study end points included hospital death vs survival, the number of days
spent in the ICU and in the hospital after the onset of mechanical ventilation, the
likelihood of requiring > or = 7 or > or = 14 days of ICU care after extubation, and
the need for transfer to either a long-term care or rehabilitation facility among
the survivors.
Of 289 intubated patients, 247 (85%) were successfully extubated, and 42 (15%) required
reintubation for failed extubation (time to reintubation 1.5+/-0.2 days). Reintubation
for extubation failure resulted in 12 additional days of mechanical ventilation. When
compared with successfully extubated patients, reintubated patients were more likely
to die in the hospital (43% vs 12%; p<0.0001), spend more time in the ICU (21.2+/-2.8
days vs 4.5+/-0.6 days; p<0.001) and in the hospital (30.5+/-3.3 days vs 16.3+/-1.2
days; p<0.001) after extubation, and require transfer to a long-term care or rehabilitation
facility (38% vs 21%; p<0.05). Using multiple logistic regression, extubation failure
was an independent predictor for death and the need for transfer to a long-term care
facility. Compared with those successfully extubated, patients who failed extubation
were seven times (p<0.0001) more likely to die, 31 times (p<0.0001) more likely to
spend > or = 14 days in the ICU after extubation, and six times (p<0.001) more likely
to need transfer to a long-term care or rehabilitation facility if they survived.
After adjusting for severity of illness and comorbid conditions, extubation failure
had a significant independent association with increased risk for death, prolonged
ICU stay, and transfer to a long-term care or rehabilitation facility. Extubation
failure may serve as an additional independent marker of severity of illness. Alternatively,
poor outcomes may be etiologically related to extubation failure. If the latter proves
to be the case, identifying patients at risk for poor outcomes from extubation failure
and instituting alternative care practices may reduce mortality, duration of ICU stay,
and need for transfer to a long-term care facility.