Abstract
Chronic respiratory diseases’ (CRDs) impact on re-intubation rate remains unclear. We investigated the association between these factors in mechanically ventilated patients. Data were extracted from the freely available online Medical Information Mart for Intensive Care III database. CRDs were defined according to ICD-9 codes. Generalised linear regression and propensity score matching were performed. Of 13,132 patients, 7.9% required re-intubation. Patients with chronic obstructive pulmonary disease (COPD) had higher re-intubation (OR 2.48, 95% CI 1.83–3.33) and mortality rates (OR 1.64, 95% CI 1.15–2.34) than those without. Patients with asthma had a lower mortality rate (OR 0.63, 95% CI 0.43–0.92) but a similar re-intubation rate to those of patients without. These findings remained stable after propensity score matching and bootstrapping analysis. The association of COPD with re-intubation was significantly stronger in patients with high oxygen-partial pressure (PaO2) or mild disease severity but was independent of carbon dioxide partial pressure. Corticosteroid use was associated with increased re-intubation rates in subgroups without CRDs (OR 1.77–1.99, p < 0.001) but not in subgroups with CRDs. COPD patients with high post-extubation PaO2 or mild disease severity should be carefully monitored as they have higher re-intubation and mortality rates.
Highlights
Chronic respiratory diseases’ (CRDs) impact on re-intubation rate remains unclear
Compared to that in the successful extubation group, the proportion of patients with chronic obstructive pulmonary disease (COPD) was significantly higher in the re-intubation group (61/1042 vs. 255/12,090, p < 0.001), whereas the proportion of patients with asthma was comparable in both groups (75/1042 vs. 800/12,090, p = 0.471)
CRDs were present in 9.5% of critically ill patients on Mechanical ventilation (MV), and different CRDs had different impacts on the prognosis of these patients
Summary
Chronic respiratory diseases’ (CRDs) impact on re-intubation rate remains unclear. We investigated the association between these factors in mechanically ventilated patients. Patients with chronic obstructive pulmonary disease (COPD) had higher re-intubation (OR 2.48, 95% CI 1.83–3.33) and mortality rates (OR 1.64, 95% CI 1.15–2.34) than those without. Patients with asthma had a lower mortality rate (OR 0.63, 95% CI 0.43–0.92) but a similar re-intubation rate to those of patients without These findings remained stable after propensity score matching and bootstrapping analysis. Corticosteroid use was associated with increased re-intubation rates in subgroups without CRDs (OR 1.77–1.99, p < 0.001) but not in subgroups with CRDs. COPD patients with high post-extubation PaO2 or mild disease severity should be carefully monitored as they have higher re-intubation and mortality rates. Evidence indicates that altered inspiratory and expiratory strength often leads to an increased risk of extubation failure[12,13], and studies have reported re-intubation rates as high as 20–30% in patients with C RDs14–16. We hypothesised that different CRDs may have differing effects on the prognosis of patients in ICUs
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