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Abstract

Introduction: Extubation failure occurs commonly in the intensive care unit (ICU) and is independently associated with morbidity, resource consumption, and death. We implemented a planned extubation safety algorithm to identify patients at risk for extubation failure. Our primary aim was to decrease the overall risk of reintubation and any airway related complications during reintubation. Secondarily, we sought to describe the effects of the intervention on the utilization of advanced airway equipment (Glidescope, fiberoptic scope) and tracheostomy. Methods: The extubation safety quality improvement project (ESQIP) was a before and after quality improvement project taking place from March 2012 to February 2013, consisting of a baseline data collection (first 6 months), an educational component with bedside signage specific to airway risk classification, distribution of laminated pocket cards illustrating the decision algorithm, inclusion of the extubation checklist in the Plan of the Day, and subsequent data collection during the intervention period (6 months). Data were collected prospectively in all intubated ICU patients. Frequency of reintubation or any airway related complications (SBP <90 mm Hg, SPO2 <90%, aspiration, cardiac arrest, or death) were compared between the baseline and intervention periods. Results: A total of 1,804 patients were included; 938 in the baseline and 866 in the post intervention period. The frequency of reintubation (n=188, 20% vs. n=162, 18.7%; p=0.47) and the composite of reintubation or reintubation related complications (n=209, 22.3% vs. n=185, 21.4%; p=0.64) were similar between baseline and intervention periods, respectively. Difficult intubation (n=22, 14% vs. n=35, 22%; p=0.08) tended to be more common and advanced airway equipment utilized more often (n=56, 27% vs. n=42, 19%; p=0.04) in the intervention period compared with baseline period. Conclusions: In the ICUs of a single large academic medical center, an extubation algorithm was associated with more frequent use of advanced airway equipment at reintubation, but did not seem to affect the frequency of reintubation overall and its related complications. The study was supported with funds from the Anesthesia Patient Safety Foundation, APSF/ASA Endowed Research Award and Ellison C. Pierce, Jr., MD Merit Award