Effect of Failed Extubation on the Outcome of Mechanical Ventilation
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 grou...
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| Veröffentlicht in: | Chest 1997-07, Vol.112 (1), p.186-192 |
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| creator | Epstein, Scott K. Ciubotaru, Ronald L. Wong, John B. |
| description | 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 >7 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 |
| doi_str_mv | 10.1378/chest.112.1.186 |
| format | Article |
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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 >7 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 ≥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.]]></description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.112.1.186</identifier><identifier>PMID: 9228375</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Artificial respiration ; Biological and medical sciences ; Case-Control Studies ; Cohort Studies ; Comorbidity ; Emergency and intensive respiratory care ; extubation ; Female ; Hospital Mortality ; Humans ; ICU outcome ; Intensive care medicine ; Intensive Care Units ; Intubation, Intratracheal - statistics & numerical data ; Length of Stay - statistics & numerical data ; Logistic Models ; Male ; mechanical ventilation ; Medical sciences ; Middle Aged ; Prospective Studies ; Respiration, Artificial - statistics & numerical data ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Failure ; Treatment Outcome ; Ventilator weaning ; Ventilator Weaning - statistics & numerical data ; weaning</subject><ispartof>Chest, 1997-07, Vol.112 (1), p.186-192</ispartof><rights>1997 The American College of Chest Physicians</rights><rights>1997 INIST-CNRS</rights><rights>COPYRIGHT 1997 Elsevier B.V.</rights><rights>Copyright American College of Chest Physicians Jul 1997</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c579t-3070f2aa483d80be8a3435f16c49aa5895e9922736ed91ce8142bc15be74e783</citedby><cites>FETCH-LOGICAL-c579t-3070f2aa483d80be8a3435f16c49aa5895e9922736ed91ce8142bc15be74e783</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2756622$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9228375$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Epstein, Scott K.</creatorcontrib><creatorcontrib>Ciubotaru, Ronald L.</creatorcontrib><creatorcontrib>Wong, John B.</creatorcontrib><title>Effect of Failed Extubation on the Outcome of Mechanical Ventilation</title><title>Chest</title><addtitle>Chest</addtitle><description><![CDATA[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 >7 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 ≥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.]]></description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Artificial respiration</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Emergency and intensive respiratory care</subject><subject>extubation</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>ICU outcome</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Intubation, Intratracheal - statistics & numerical data</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Logistic Models</subject><subject>Male</subject><subject>mechanical ventilation</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial - statistics & numerical data</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><subject>Treatment Failure</subject><subject>Treatment Outcome</subject><subject>Ventilator weaning</subject><subject>Ventilator Weaning - statistics & numerical data</subject><subject>weaning</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kc9rFTEQx4Mo9Vk9exIWEU_ua37sbjbHUl9VqPRSvIa87ORtSjapSbbqf2_aXapIJYEwzGdmvpkvQq8J3hLG-xM9QspbQuiWbEnfPUEbIhipWduwp2iDMaE16wR9jl6kdI1LTER3hI4EpT3j7QZ93BkDOlfBVOfKOhiq3c8871W2wVfl5hGqyznrMMEd8xX0qLzVylXfwGfr7sGX6JlRLsGr9T1GV-e7q7PP9cXlpy9npxe1brnINcMcG6pU07Ohx3voFWtYa0inG6FU24sWRBHGWQeDIBp60tC9Ju0eeAO8Z8fo_dL2Jobvc_m3nGzS4JzyEOYkuSBNzzEv4Nt_wOswR1-kSYpx0zBMcYE-LNBBOZDWm5Cj0gfwEJULHkzZhjwt62IdxaLg9SN4OQNMVj_Gnyy8jiGlCEbeRDup-EsSLO-sk_fWyWKdJLJYVyrerKrn_QTDA796VfLv1rxKxQATldc2PWCUt11H6Z_Boz2MP2wEmSblXGnKlpHrLv4eLJYKKN7dWogyaQtew1CqdZZDsP8V_RttysPm</recordid><startdate>19970701</startdate><enddate>19970701</enddate><creator>Epstein, Scott K.</creator><creator>Ciubotaru, Ronald L.</creator><creator>Wong, John B.</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><general>Elsevier B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>19970701</creationdate><title>Effect of Failed Extubation on the Outcome of Mechanical Ventilation</title><author>Epstein, Scott K. ; Ciubotaru, Ronald L. ; Wong, John B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c579t-3070f2aa483d80be8a3435f16c49aa5895e9922736ed91ce8142bc15be74e783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Artificial respiration</topic><topic>Biological and medical sciences</topic><topic>Case-Control Studies</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Emergency and intensive respiratory care</topic><topic>extubation</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>ICU outcome</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Intubation, Intratracheal - statistics & numerical data</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Logistic Models</topic><topic>Male</topic><topic>mechanical ventilation</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial - statistics & numerical data</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><topic>Treatment Failure</topic><topic>Treatment Outcome</topic><topic>Ventilator weaning</topic><topic>Ventilator Weaning - statistics & numerical data</topic><topic>weaning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Epstein, Scott K.</creatorcontrib><creatorcontrib>Ciubotaru, Ronald L.</creatorcontrib><creatorcontrib>Wong, John B.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Epstein, Scott K.</au><au>Ciubotaru, Ronald L.</au><au>Wong, John B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Failed Extubation on the Outcome of Mechanical Ventilation</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1997-07-01</date><risdate>1997</risdate><volume>112</volume><issue>1</issue><spage>186</spage><epage>192</epage><pages>186-192</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract><![CDATA[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 >7 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 ≥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.]]></abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>9228375</pmid><doi>10.1378/chest.112.1.186</doi><tpages>7</tpages></addata></record> |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Artificial respiration Biological and medical sciences Case-Control Studies Cohort Studies Comorbidity Emergency and intensive respiratory care extubation Female Hospital Mortality Humans ICU outcome Intensive care medicine Intensive Care Units Intubation, Intratracheal - statistics & numerical data Length of Stay - statistics & numerical data Logistic Models Male mechanical ventilation Medical sciences Middle Aged Prospective Studies Respiration, Artificial - statistics & numerical data Risk Factors Severity of Illness Index Time Factors Treatment Failure Treatment Outcome Ventilator weaning Ventilator Weaning - statistics & numerical data weaning |
| title | Effect of Failed Extubation on the Outcome of Mechanical Ventilation |
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