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

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

Abstract

Introduction: Extubation 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.

Methods: A 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).

Results: The 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 33,926 US dollars (95% CI = 22,573 US dollars - 45,280 US dollars; P < 0.01).

Conclusion: Extubation 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.

Figures

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Figure 1
Methodology for constructing the study.

References

    1. Esteban A, Frutos F, Tobin M, Alia I, Solsona J, Valverdu I, Fernandez R, De la Cal JF, Benito S, Tomas R, et al. A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med. 1995;332:345–352. doi: 10.1056/NEJM199502093320601.
    1. Ely E, Baker A, Dunagon D, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EF. Effect on duration of mechanical ventilation of identifying patient capable of breathing spontaneously. N Engl J Med. 1996;335:1864–1869. doi: 10.1056/NEJM199612193352502.
    1. Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Mancebo J. Clinical characteristics, respiratory functional parameters and outcome of a 2-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med. 1998;158:1855–1862.
    1. Pronovost PJ, Garrett E, Dorman T, Jenckes M, Webb TH, III, Breslow M, Rosenfeld B, Bass E. Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery. Lang Arch Surg. 2001;386:249–256. doi: 10.1007/s004230100216.
    1. Esteban A, Alia I, Gordo F, Fernandez R, Solsona JF, Vallverdu I, Macias S, Allegue JM, Blanco J, Carriedo D, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1997;156:459–465.
    1. Epstein S, Ciubotaru R, Wong J. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997;112:186–192.
    1. Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med. 1999;27:340–347. doi: 10.1097/00003246-199902000-00041.
    1. Dupont H, LePort Y, Paugham-Burtz C, Mantz J, Desmonts M. Re-intubation after planned extubation in surgical ICU patients: a case-control study. Intensive Care Med. 2001;27:1875–1880. doi: 10.1007/s001340101101.
    1. Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med. 1998;158:489–493.
    1. Torres A, Gatell J, Aznar E, El-Ebiary M, Puig de la Bellacasa J, Gonzalez J, Ferrer M, Rodriguez-Roisin R. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med. 1995;152:137–141.
    1. Pines JM, Fager SS, Milzman DP. A review of costing methodologies in critical care studies. J Crit Care. 2002;17:181–186. doi: 10.1053/jcrc.2002.35811.

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