Abstract
Objectives: While it is known there is a poor prognosis for medical ICU patients who require reintubation after failed extubation, no data exist for emergency center ICU patient outcomes. Preliminary study to reduce failed extubation, we examined indications for mechanical ventilation, rates of extubation failure, time to reintubation, the etiology for extubation failure, and outcomes in emergency center ICU patients. Methods: During an 18-month period, this university hospital retrospective cohort study collected data from patients admitted to the emergency center ICU who were mechanically ventilated by an endotracheal tube for more than 6 hours. Extubation failure was defined as reinstitution of mechanical ventilation within 72 hours. Results: Causes leading to mechanical ventilation in 114 intubations included pulmonary 18 (15.8%), cardiac 11 (9.6%), neurologic 23 (20.2%) and other 62 (54.4%). A total of 12 out of 114 (10.5%) required reintubation due to failed extubation (time to reintubation: 1.5 (1.0–7.8) hours). Reintubation was airway-related in 11 patients, and nonairway-related in 1 patient. Out of these 12 patients, 1 (8.3%) died. Conclusions: As compared to medical ICU patients, the extubation failure rate was similar, the time to reintubation was shorter, and there was a lower mortality of failed extubation. While pulmonary and cardiac factors were minor causes of the mechanical ventilation, the major etiology for reintubation was airway-related. Current findings are in contrast to that normally seen for medical ICU patients, and thus, lower mortality rates might exist in emergency center ICU patients.
