The outcome of extubation failure in a community hospital intensive care unit: a cohort study.

Christopher W Seymour,Barry D Fuchs,Anthony Martinez,Jason D Christie

doi:10.1186/cc2913

Abstract

IntroductionExtubation failure has been associated with poor intensive care unit (ICU) and hospital outcomes in tertiary care medical centers. Given the large proportion of critical care delivered in the community setting, our purpose was to determine the impact of extubation failure on patient outcomes in a community hospital ICU.MethodsA retrospective cohort study was performed using data gathered in a 16-bed medical/surgical ICU in a community hospital. During 30 months, all patients with acute respiratory failure admitted to the ICU were included in the source population if they were mechanically ventilated by endotracheal tube for more than 12 hours. Extubation failure was defined as reinstitution of mechanical ventilation within 72 hours (n = 60), and the control cohort included patients who were successfully extubated at 72 hours (n = 93).ResultsThe primary outcome was total ICU length of stay after the initial extubation. Secondary outcomes were total hospital length of stay after the initial extubation, ICU mortality, hospital mortality, and total hospital cost. Patient groups were similar in terms of age, sex, and severity of illness, as assessed using admission Acute Physiology and Chronic Health Evaluation II score (P > 0.05). Both ICU (1.0 versus 10 days; P < 0.01) and hospital length of stay (6.0 versus 17 days; P < 0.01) after initial extubation were significantly longer in reintubated patients. ICU mortality was significantly higher in patients who failed extubation (odds ratio = 12.2, 95% confidence interval [CI] = 1.5–101; P < 0.05), but there was no significant difference in hospital mortality (odds ratio = 2.1, 95% CI = 0.8–5.4; P < 0.15). Total hospital costs (estimated from direct and indirect charges) were significantly increased by a mean of US$33,926 (95% CI = US$22,573–45,280; P < 0.01).ConclusionExtubation failure in a community hospital is univariately associated with prolonged inpatient care and significantly increased cost. Corroborating data from tertiary care centers, these adverse outcomes highlight the importance of accurate predictors of extubation outcome.

Highlights

Extubation failure has been associated with poor intensive care unit (ICU) and hospital outcomes in tertiary care medical centers
This study demonstrates that failed extubation had an adverse impact on clinical outcomes in patients recovering from acute respiratory failure in a community hospital ICU
We have demonstrated that extubation failure may be an important ICU complication because of its association with adverse patient outcomes and cost in a community hospital

Summary

Introduction

Extubation failure has been associated with poor intensive care unit (ICU) and hospital outcomes in tertiary care medical centers. Secondary outcomes were total hospital length of stay after the initial extubation, ICU mortality, hospital mortality, and total hospital cost. Patient groups were similar in terms of age, sex, and severity of illness, as assessed using admission Acute Physiology and Chronic Health Evaluation II score (P > 0.05) Both ICU (1.0 versus 10 days; P < 0.01) and hospital length of stay (6.0 versus 17 days; P < 0.01) after initial extubation were significantly longer in reintubated patients. Compared with patients who are successfully extubated, patients who are reintubated have worse clinical outcomes, including prolonged lengths of stay (LOSs) in the intensive care unit (ICU) and hospital, and increased mortality [1,2,3,4]. When controlling for disease severity using multivariate analysis, recent studies [5,6] found extubation failure to be independently associated with hospital death, this is not a uniform finding [7,8]

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