The outcome and predictors of failed extubation in intensive care patients - The elderly is an important predictor

Ai Chin Cheng, Kuo Chen Cheng, Chin Ming Chen, Shu Chen Hsing, Mei Yi Sung

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

Background: Weaning off the ventilator and removal of the endotracheal tube requires appropriate timing and supportive care in order to avoid reintubation. In this study, the incidence, outcome, and factors predictive of failed extubation (reintubation within 48 hours), as well as the associated mortality in critically ill patients on mechanical ventilation in the adult intensive care unit (ICU), were studied. Methods: The medical records of all patients who experienced planned extubation in the ICUs of Chi-Mei Medical Center in 2008 were reviewed. The primary endpoints were factors predicting failed extubation and mortality. The secondary endpoint was the outcome of failed extubation. Results: Among the 1794 patients experiencing planned extubation, 167 patients (9.3%) required reintubation within 48 hours. The overall mortality rate was 8.1%. Using multivariate analyses, the factors predicting failed extubation were age ≥65 years and medical patients. The predictors of mortality included age ≥65 years, higher Acute Physiology and Chronic Health Evaluation II scores, and failed extubation. The patients with failed extubation had significantly longer ICU and hospital stays (15.2 vs. 6.6 days, and 40.3 vs. 24.0 days, respectively), increased incidence of tracheostomy (21.6% vs. 1.5%), a higher hospital mortality (45.5% vs. 4.2%), and higher hospital costs (52.3 vs. 30.4 × 10 4 New Taiwan dollars) when compared with patients who had successful extubation. Conclusion: Our study indicated that patients with failed extubation experienced significantly increased admission expenditure, increased tracheostomy rate, and higher hospital mortality. Advanced age should be considered an important risk factor for failed extubation and overall mortality when planning extubation in critically ill ICU patients.

Original languageEnglish
Pages (from-to)206-211
Number of pages6
JournalInternational Journal of Gerontology
Volume5
Issue number4
DOIs
Publication statusPublished - Dec 2011

Fingerprint

Critical Care
Mortality
Intensive Care Units
Tracheostomy
Hospital Mortality
Critical Illness
Ventilator Weaning
APACHE
Hospital Costs
Incidence
Health Expenditures
Taiwan
Artificial Respiration
Medical Records
Length of Stay
Multivariate Analysis

Keywords

  • elderly
  • endotracheal intubation
  • failed extubation
  • planned extubation

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

The outcome and predictors of failed extubation in intensive care patients - The elderly is an important predictor. / Cheng, Ai Chin; Cheng, Kuo Chen; Chen, Chin Ming; Hsing, Shu Chen; Sung, Mei Yi.

In: International Journal of Gerontology, Vol. 5, No. 4, 12.2011, p. 206-211.

Research output: Contribution to journalReview article

Cheng, Ai Chin ; Cheng, Kuo Chen ; Chen, Chin Ming ; Hsing, Shu Chen ; Sung, Mei Yi. / The outcome and predictors of failed extubation in intensive care patients - The elderly is an important predictor. In: International Journal of Gerontology. 2011 ; Vol. 5, No. 4. pp. 206-211.
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abstract = "Background: Weaning off the ventilator and removal of the endotracheal tube requires appropriate timing and supportive care in order to avoid reintubation. In this study, the incidence, outcome, and factors predictive of failed extubation (reintubation within 48 hours), as well as the associated mortality in critically ill patients on mechanical ventilation in the adult intensive care unit (ICU), were studied. Methods: The medical records of all patients who experienced planned extubation in the ICUs of Chi-Mei Medical Center in 2008 were reviewed. The primary endpoints were factors predicting failed extubation and mortality. The secondary endpoint was the outcome of failed extubation. Results: Among the 1794 patients experiencing planned extubation, 167 patients (9.3{\%}) required reintubation within 48 hours. The overall mortality rate was 8.1{\%}. Using multivariate analyses, the factors predicting failed extubation were age ≥65 years and medical patients. The predictors of mortality included age ≥65 years, higher Acute Physiology and Chronic Health Evaluation II scores, and failed extubation. The patients with failed extubation had significantly longer ICU and hospital stays (15.2 vs. 6.6 days, and 40.3 vs. 24.0 days, respectively), increased incidence of tracheostomy (21.6{\%} vs. 1.5{\%}), a higher hospital mortality (45.5{\%} vs. 4.2{\%}), and higher hospital costs (52.3 vs. 30.4 × 10 4 New Taiwan dollars) when compared with patients who had successful extubation. Conclusion: Our study indicated that patients with failed extubation experienced significantly increased admission expenditure, increased tracheostomy rate, and higher hospital mortality. Advanced age should be considered an important risk factor for failed extubation and overall mortality when planning extubation in critically ill ICU patients.",
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AB - Background: Weaning off the ventilator and removal of the endotracheal tube requires appropriate timing and supportive care in order to avoid reintubation. In this study, the incidence, outcome, and factors predictive of failed extubation (reintubation within 48 hours), as well as the associated mortality in critically ill patients on mechanical ventilation in the adult intensive care unit (ICU), were studied. Methods: The medical records of all patients who experienced planned extubation in the ICUs of Chi-Mei Medical Center in 2008 were reviewed. The primary endpoints were factors predicting failed extubation and mortality. The secondary endpoint was the outcome of failed extubation. Results: Among the 1794 patients experiencing planned extubation, 167 patients (9.3%) required reintubation within 48 hours. The overall mortality rate was 8.1%. Using multivariate analyses, the factors predicting failed extubation were age ≥65 years and medical patients. The predictors of mortality included age ≥65 years, higher Acute Physiology and Chronic Health Evaluation II scores, and failed extubation. The patients with failed extubation had significantly longer ICU and hospital stays (15.2 vs. 6.6 days, and 40.3 vs. 24.0 days, respectively), increased incidence of tracheostomy (21.6% vs. 1.5%), a higher hospital mortality (45.5% vs. 4.2%), and higher hospital costs (52.3 vs. 30.4 × 10 4 New Taiwan dollars) when compared with patients who had successful extubation. Conclusion: Our study indicated that patients with failed extubation experienced significantly increased admission expenditure, increased tracheostomy rate, and higher hospital mortality. Advanced age should be considered an important risk factor for failed extubation and overall mortality when planning extubation in critically ill ICU patients.

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