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Risk factors for extubation failure at a level I trauma center: does the specialty of the intensivist matter?
  1. Jordan A Weinberg,
  2. Lily R Stevens,
  3. Pamela W Goslar,
  4. Terrell M Thompson,
  5. Jessica L Sanford,
  6. Scott R Petersen
  1. Department of Surgery, Dignity Health—St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
  1. Correspondence to Dr Jordan A Weinberg; jordan.weinberg{at}dignityhealth.org

Abstract

Introduction Extubation failure in critically ill patients is associated with higher morbidity and mortality. Although predictors of failed extubation have been previously determined in intensive care unit (ICU) cohorts, relatively less attention has been directed toward this issue in patients with trauma. The aim of this study was to identify predictors of extubation failure among patients with trauma in a multidisciplinary ICU setting.

Methods A prospective observational study of extubation failures (EF) was conducted at an American College of Surgeons level I trauma center over 3 years (2011–2013). Case–control patients (CC) were then compared with the study group (EF) with respect to demographic/clinical characteristics and outcomes. Failure of extubation was defined as reintubation within 72 hours following planned extubation.

Results 7830 patients were admitted to the trauma service and 1098 (14%) underwent mechanical ventilation. 63 patients met inclusion criteria for the EF group and 63 comprised the CC group. The overall rate of extubation failure was 5.7% and mean time to reintubation was 13.0 hours. Groups (EF vs CC) were similar for Injury Severity Score (21 vs 21), Glasgow Coma Scale at extubation (11 vs 10), number of comorbidities (1.5 vs 1.7), injury mechanism (blunt 79% vs 74%), and body mass index (27.9 vs 27.2). In addition, groups were similar with respect to weaning protocol compliance (84% vs 89%, p=0.57). EF group had significantly increased ICU length of stay (LOS) (15.7 vs 7.4 days, p<0.001), ventilator days (13.3 vs 4.8, p<0.001), and mortality (9.5% vs 0%, p=0.03). Multiple regression analysis identified that EF was associated with increased odds of: (1) temperature >38°C at time of extubation (OR 5.9, 95% CI 1.7 to 20.8), and (2) non-surgeon intensivist consultation (OR 24.2, 95% CI 5.5 to 105.9).

Conclusions Extubation failure is associated with increased LOS, ventilator days, and mortality in patients with trauma. Fever at time of extubation is associated with extubation failure, and the presence of such should give pause in the decision to extubate. Non-surgeon intensivist involvement increases risk of extubation failure, and a surgical critical care service may be most appropriate for the management of ventilated patients with trauma.

Level of evidence III, Prognostic and epidemiological.

  • endotracheal intubation
  • Intensive Care
  • Mechanical Ventilation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Presented at the poster session at the American Association for the Surgery of Trauma Annual Meeting, 14 September 2016 in Waikoloa, Hawaii.

  • Contributors SRP, LRS, and PWG conceptualized and designed the study. PWG and LRS contributed in acquisition of data. JAW, PWG, TMT, JLS, and SRP analyzed and interpreted the data. JAW, JLS, PWG, and SRP drafted the manuscript. JAW, JLS, PWG, SRP, LRS, and TMT critically revised the study.

  • Competing interests None declared.

  • Ethics approval The study was approved by St. Joseph's Hospital and Medical Center IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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