Prospective observational study of predictors of re-intubation following extubation in the surgical ICU

Annop Piriyapatsom, Elizabeth C. Williams, Karen Waak, Karim S. Ladha, Matthias Eikermann, Ulrich H. Schmidt

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Re-intubation is associated with high morbidity and mortality. There is limited information regarding the risk factors that predispose patients admitted to the surgical ICU to re-intubation. We hypothesized that preoperative comorbidities, acquired muscular weakness, and renal dysfunction would be predictors of re-intubation in the surgical ICU population. METHODS: This was a prospective observational study in 2 surgical ICUs of a large tertiary hospital. All patients who were extubated during their surgical ICU stay were included. Demographic and clinical data were collected before and after extubation. The primary outcome was re-intubation within 72 h. Using multivariate logistic regression analysis, independent risk factors of re-intubation were determined, and a prediction score was developed. RESULTS: Between December 1, 2012, and January 31, 2014, we included 764 consecutive subjects. Of these, 65 subjects (8.5%) required re-intubation. Independent risk factors of re-intubation were blood urea nitrogen level of >8.2 mmol/L (odds ratio [OR] 3.66, 95% CI 1.97-6.80), hemoglobin level of <75 g/L (OR 2.10, 95% CI 1.23-3.61), and muscle strength of <3 (OR 2.03, 95% CI 1.16-3.55). The presence of all 3 risk factors was associated with an estimated probability for re-intubation of 26.8%. CONCLUSIONS: In noncardiac surgery, surgical ICU subjects, elevated blood urea nitrogen level, low hemoglobin level, and muscle weakness were identified as independent risk factors for re-intubation. The presence of these risk factors can potentially aid clinicians in making informed decisions regarding optimal airway management in patients considered for an extubation attempt. (ClinicalTrials.gov registration NCT01967056.)

Original languageEnglish (US)
Pages (from-to)306-315
Number of pages10
JournalRespiratory care
Volume61
Issue number3
DOIs
StatePublished - Mar 2016
Externally publishedYes

Keywords

  • Critically ill
  • Prediction score
  • Re-intubation
  • Risk factors
  • Surgical

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Fingerprint

Dive into the research topics of 'Prospective observational study of predictors of re-intubation following extubation in the surgical ICU'. Together they form a unique fingerprint.

Cite this