Abstract
Purpose
Reintubation (RI) in surgical intensive care unit (SICU) patients is associated with significant morbidity and mortality. Reported RI rates are lower in surgical populations (6-9%) than in medical populations. This study evaluated the rate, risk factors, and outcomes associated with RI in a SICU cohort.
Methods
A retrospective cohort study of adults admitted to a Level-1 trauma center SICU who received mechanical ventilation between 2019 and 2020 was performed. Exclusion criteria included age
Results
Of 667 patients, 52 (7.8%) experienced RI. In the full-cohort model, atrial fibrillation, spinal cord injury, alcohol withdrawal, ventilator-associated pneumonia (VAP), combined propofol–dexmedetomidine sedation, and admitting service were independently associated with RI; VAP timing relative to RI was uncertain. RI occurred in 5.8% of patients intubated for an operative procedure and 11.2% of those intubated for a nonoperative indication (
P
= .011). Compared with successful extubation, RI was associated with longer mechanical ventilation (11 vs 1 day), intensive care unit (ICU) stay (15 vs 2 days) and hospital stay (25 vs 10 days), as well as higher rates of tracheostomy (63% vs 2%), delirium (77% vs 33%), VAP (29% vs 2%), and in-hospital mortality (23% vs 1%, all
P
Conclusions
The incidence of RI in this SICU was 7.8% and was associated with markedly worse outcomes. Patient-specific risk assessment may help guide risk-stratified post-extubation monitoring and respiratory support. The exploratory subgroup findings require prospective validation.