The effect of extubation failure on outcome in a multidisciplinary Australian intensive care unit
ABSTRACT
Background: A reported association between extubationfailure (EF) and increased hospital length of stay andmortality led us to assess outcome of EF in an Australianintensive care unit.
Design and setting: Non-interventional cohort study in the intensive care/high dependency unit of a tertiary referral hospital, 2000-2003.
Methods: EF was defined as reintubation within 72 hoursof extubation. Causes of EF were determined by review ofthe clinical notes and prospective record of the EF event.Patients were excluded if they were aged <= 14 years, self-extubated,were reintubated to replace a defectiveendotracheal tube, or had been extubated but werereturning to the operating theatre. Physiological variablesused to calculate severity of illness score were analysed toascertain correlation with EF.
Results: 2761 patients were electively extubated, and 52(1.8%) fulfilled the criteria for EF. Compared with thosesuccessfully extubated, EF patients had a higher 24 h APACHEII score (18.0 ±7.0 [mean ±SD] v 15.3 ±7.4, P=0.009),significant increases in length of stay in ICU (12.8 ±8.3 v3.0 ±6.0 days, P<0.001) and hospital (33.5 ±40.8 v18.0 ±28.6 days, P<0.001) and tracheostomy rate (38.5% v3.5%, P<0.001).The commonest cause of EF was excesssecretions or aspiration (32%). EF was independentlyassociated with hospital mortality (odds ratio [OR], 2.10;95% CI, 1.00-4.41; P=0.048) and low serum albumin levelon admission (OR, 0.75; 95% CI, 0.55-1.00; P=0.05).Neither aetiology of airway failure (OR, 2.21; 95% CI, 0.56-8.75; P=0.25) nor time to reintubation (OR, 0.99; 95% CI,0.97-1.01; P=0.76) were associated with mortality.
Conclusion: Our findings confirm an increased risk ofadverse outcomes for patients with EF. We observed acomparatively low EF rate. Confirmation in similar patientcohorts is required.
Crit Care Resusc 2006; 8: 328-333
