TY - JOUR
T1 - Cumulative probability and time to reintubation in U.S. ICUs
AU - Miltiades, Andrea N.
AU - Gershengorn, Hayley B.
AU - Hua, May
AU - Kramer, Andrew A.
AU - Li, Guohua
AU - Wunsch, Hannah
N1 - Publisher Copyright:
© 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Objective: Reintubation after liberation from mechanical ventilation is viewed as an adverse event in ICUs. We sought to describe the frequency of reintubations across U.S. ICUs and to propose a standard, appropriate time cutoff for reporting of reintubation events. Design and Setting: We conducted a cohort study using data from the Project IMPACT database of 185 diverse ICUs in the United States. Patients: We included patients who received mechanical ventilation and excluded patients who received a tracheostomy, had a do-not-resuscitate order placed, or died prior to first extubation. Measurements and Main Results: We assessed the percentage of patients extubated who were reintubated; the cumulative probability of reintubation, with death and do-not-resuscitate orders after extubation modeled as competing risks, and time to reintubation. Among 98,367 patients who received mechanical ventilation without death or tracheostomy prior to extubation, 9,907 (10.1%) were reintubated, with a cumulative probability of 10.0%. Median time to reintubation was 15 hours (interquartile range, 2-45 hr). Of patients who required reintubation in the ICU, 90% did so within the first 96 hours after initial extubation; this was consistent across various patient subtypes (89.3% for electives surgical patients up to 94.8% for trauma patients) and ICU subtypes (88.6% for cardiothoracic ICUs to 93.5% for medical ICUs). Conclusions: The reintubation rate for ICU patients liberated from mechanical ventilation in U.S. ICUs is approximately 10%. We propose a time cutoff of 96 hours for reintubation definitions and benchmarking efforts, as it captures 90% of ICU reintubation events. Reintubation rates can be reported as simple percentages, without regard for deaths or changes in goals of care that might occur.
AB - Objective: Reintubation after liberation from mechanical ventilation is viewed as an adverse event in ICUs. We sought to describe the frequency of reintubations across U.S. ICUs and to propose a standard, appropriate time cutoff for reporting of reintubation events. Design and Setting: We conducted a cohort study using data from the Project IMPACT database of 185 diverse ICUs in the United States. Patients: We included patients who received mechanical ventilation and excluded patients who received a tracheostomy, had a do-not-resuscitate order placed, or died prior to first extubation. Measurements and Main Results: We assessed the percentage of patients extubated who were reintubated; the cumulative probability of reintubation, with death and do-not-resuscitate orders after extubation modeled as competing risks, and time to reintubation. Among 98,367 patients who received mechanical ventilation without death or tracheostomy prior to extubation, 9,907 (10.1%) were reintubated, with a cumulative probability of 10.0%. Median time to reintubation was 15 hours (interquartile range, 2-45 hr). Of patients who required reintubation in the ICU, 90% did so within the first 96 hours after initial extubation; this was consistent across various patient subtypes (89.3% for electives surgical patients up to 94.8% for trauma patients) and ICU subtypes (88.6% for cardiothoracic ICUs to 93.5% for medical ICUs). Conclusions: The reintubation rate for ICU patients liberated from mechanical ventilation in U.S. ICUs is approximately 10%. We propose a time cutoff of 96 hours for reintubation definitions and benchmarking efforts, as it captures 90% of ICU reintubation events. Reintubation rates can be reported as simple percentages, without regard for deaths or changes in goals of care that might occur.
KW - Airway extubation
KW - Artificial respiration
KW - Intensive care
KW - Respiration
KW - Respiratory insufficiency
KW - Ventilator weaning
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U2 - 10.1097/CCM.0000000000002327
DO - 10.1097/CCM.0000000000002327
M3 - Article
C2 - 28288027
AN - SCOPUS:85015032357
SN - 0090-3493
VL - 45
SP - 835
EP - 842
JO - Critical care medicine
JF - Critical care medicine
IS - 5
ER -