Risk factors associated with early reintubation in trauma patients: A prospective observational study

Carlos V R Brown, Jacob B. Daigle, Kelli H. Foulkrod, Brandee Brouillette, Adam Clark, Clea Czysz, Marnie Martinez, Hassie Cooper

Research output: Contribution to journalReview article

31 Scopus citations

Abstract

BACKGROUND: After mechanical ventilation, extubation failure is associated with poor outcomes and prolonged hospital and intensive care unit (ICU) stays. We hypothesize that specific and unique risk factors exist for failed extubation in trauma patients. The purpose of this study was to identify the risk factors in trauma patients. METHODS: We performed an 18-month (January 2008-June 2009) prospective, cohort study of all adult (8 years or older) trauma patients admitted to the ICU who required mechanical ventilation. Failure of extubation was defined as reintubation within 24 hours of extubation. Patients who failed extubation (failed group) were compared with those who were successfully extubated (successful group) to identify independent risk factors for failed extubation. RESULTS: A total of 276 patients were 38 years old, 76% male, 84% sustained blunt trauma, with an mean Injury Severity Score = 21, Glasgow Coma Scale (GCS) score = 7, and systolic blood pressure = 125 mm Hg. Indications for initial intubation included airway (4%), breathing (13%), circulation (2%), and neurologic disability (81%). A total of 17 patients (6%) failed extubation and failures occurred a mean of 15 hours after extubation. Independent risk factors to fail extubation included spine fracture, airway intubation, GCS at extubation, and delirium tremens. Patients who failed extubation spent more days in the ICU (11 vs. 6, p = 0.006) and hospital (19 vs. 11, p = 0.002). Mortality was 6% (n = 1) in the failed group and 0.4% (n = 1) in the successful extubation group. CONCLUSIONS: Independent risk factors for trauma patients to fail extubation include spine fracture, initial intubation for airway, GCS at extubation, and delirium tremens. Trauma patients with these four risk factors should be observed for 24 hours after extubation, because the mean time to failure was 15 hours. In addition, increased complications, extended need for mechanical ventilation, and prolonged ICU and hospital stays should be expected for trauma patients who fail extubation.

Original languageEnglish (US)
Pages (from-to)37-41
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue number1
DOIs
StatePublished - Jul 1 2011

Keywords

  • Extubation
  • ICU: critical care
  • Mechanical ventilation
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Risk factors associated with early reintubation in trauma patients: A prospective observational study'. Together they form a unique fingerprint.

  • Cite this

    Brown, C. V. R., Daigle, J. B., Foulkrod, K. H., Brouillette, B., Clark, A., Czysz, C., Martinez, M., & Cooper, H. (2011). Risk factors associated with early reintubation in trauma patients: A prospective observational study. Journal of Trauma - Injury, Infection and Critical Care, 71(1), 37-41. https://doi.org/10.1097/TA.0b013e31821e0c6e