Cumulative probability and time to reintubation in U.S. ICUs

Andrea N. Miltiades, Hayley B. Gershengorn, May Hua, Andrew A. Kramer, Guohua Li, Hannah Wunsch

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)835-842
Number of pages8
JournalCritical Care Medicine
Volume45
Issue number5
DOIs
StatePublished - May 1 2017

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Keywords

  • Airway extubation
  • Artificial respiration
  • Intensive care
  • Respiration
  • Respiratory insufficiency
  • Ventilator weaning

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Miltiades, A. N., Gershengorn, H. B., Hua, M., Kramer, A. A., Li, G., & Wunsch, H. (2017). Cumulative probability and time to reintubation in U.S. ICUs. Critical Care Medicine, 45(5), 835-842. https://doi.org/10.1097/CCM.0000000000002327

Cumulative probability and time to reintubation in U.S. ICUs. / Miltiades, Andrea N.; Gershengorn, Hayley B.; Hua, May; Kramer, Andrew A.; Li, Guohua; Wunsch, Hannah.

In: Critical Care Medicine, Vol. 45, No. 5, 01.05.2017, p. 835-842.

Research output: Contribution to journalArticle

Miltiades, AN, Gershengorn, HB, Hua, M, Kramer, AA, Li, G & Wunsch, H 2017, 'Cumulative probability and time to reintubation in U.S. ICUs', Critical Care Medicine, vol. 45, no. 5, pp. 835-842. https://doi.org/10.1097/CCM.0000000000002327
Miltiades AN, Gershengorn HB, Hua M, Kramer AA, Li G, Wunsch H. Cumulative probability and time to reintubation in U.S. ICUs. Critical Care Medicine. 2017 May 1;45(5):835-842. https://doi.org/10.1097/CCM.0000000000002327
Miltiades, Andrea N. ; Gershengorn, Hayley B. ; Hua, May ; Kramer, Andrew A. ; Li, Guohua ; Wunsch, Hannah. / Cumulative probability and time to reintubation in U.S. ICUs. In: Critical Care Medicine. 2017 ; Vol. 45, No. 5. pp. 835-842.
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abstract = "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.",
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KW - Airway extubation

KW - Artificial respiration

KW - Intensive care

KW - Respiration

KW - Respiratory insufficiency

KW - Ventilator weaning

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