Unplanned intubation: When and why does this deadly complication occur?

Milgrom, Daniel P.; Njoku, Victor; Fecher, Alison M.; Kilbane, E. Molly; Pitt, Henry A.

doi:10.1016/j.surg.2013.05.006

Cited by 15 publications

(10 citation statements)

References 24 publications

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“…18 Milgrom et al explored unplanned intubations in surgical patients and found that advanced age, multiple comorbidities, and frailty were risk factors. 19 They also showed that the 4 most common causes of unplanned intubation in their study were sepsis, aspiration/pneumonia, excess secretions, and fluid overload. 19 Our higher rates of unplanned intubation may be due to these issues as well, which are known to be sequelae of brain injury.…”

Section: Discussionmentioning

confidence: 90%

“…19 They also showed that the 4 most common causes of unplanned intubation in their study were sepsis, aspiration/pneumonia, excess secretions, and fluid overload. 19 Our higher rates of unplanned intubation may be due to these issues as well, which are known to be sequelae of brain injury. In fact, 40%-65% of patients with TBI will develop pneumonia, which can progress to systemic sepsis.…”

Section: Discussionmentioning

confidence: 90%

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The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury

Tracy

Carlin

Tyson

et al. 2020

The American Surgeon

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Background Frailty has been studied extensively in trauma, but there is minimal research detailing its impact on traumatic brain injury (TBI). We hypothesized that the 11-item modified frailty index (mFI-11) would predict complications and discharge outcomes in patients with TBI. Methods A retrospective review of our trauma quality improvement program (TQIP) registry was conducted for all patients with TBI. The mFI-11 score was calculated for each patient. Multivariable logistic regression was used to assess the relationship between mFI-11 and cardiovascular, infectious, pulmonary, renal, thromboembolic, and unplanned complications (ie, unplanned intensive care unit [ICU] admission, intubation, or return to the operating room). Results There were 2352 patients with TBI of whom 61.6% (n = 1450) were not frail, 19.3% (n = 454) were mildly frail, and 19.1% (n = 448) were moderately to severely frail. Higher frailty scores were associated with increasing age ( P < .0001) and decreasing injury severity score [ISS] ( P = 0.001). Higher frailty scores also correlated with increasing rates of a skilled nursing facility/long-term acute care hospital/rehabilitation discharge ( P = .0002). On multivariable logistic regression adjusting for age, Glasgow Coma Scale (GCS) score, ISS, mechanism, and sex, moderate to severe frailty increased the odds of acute kidney injury (odds ratio [OR] 2.06, 95% CI 1.07-3.99, P = .03) and any unplanned event (OR 1.6, 95% CI 1.1-2.3, P = .01). Conclusion Frailty measured by the mFI-11 is associated with greater rates of discharge to unfavorable locations and increased odds of acute kidney injury and unplanned events among patients with TBI. These findings suggest that frail patients with TBIs require greater vigilance to avoid such unanticipated outcomes.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 90%

The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury

Tracy

Carlin

Tyson

et al. 2020

The American Surgeon

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“…Given the particularly high adjusted odds ratio for unplanned intubation, we would recommend use of early warning systems and a low threshold to perform abdominal and pelvic CT scans to detect collections which require drainage. 26,27 Milgrom et al showed sepsis/shock to be significantly associated with unplanned intubation and 67% of patients who had sepsis had an organ space infection. 25 These complications are likely heralds for an underlying organ space SSI or a pancreatic fistula.…”

Section: Discussionmentioning

confidence: 99%

Patient-specific predictors of failure to rescue after pancreaticoduodenectomy

Gleeson

Clarke

Morano

et al. 2019

HPB

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“…In the first 30 days postoperatively, the most common causes are sepsis, aspiration, and pneumonia. 1 In all, 50 per cent of PUI occurs within the first 72 hours postoperatively, most commonly from pulmonary edema, fluid overload, narcotic overdose, excess secretions, anesthesia mismanagement, pneumonia, and cardiac complications. 5,6 Each of these underlying causes has various potential risk factors making PUI a complex problem.…”

Section: Discussionmentioning

confidence: 99%

“…Potential causes include sepsis, aspiration, fluid overload, pneumonia, congestive heart failure (CHF), and anesthesia complications. 1,2 Several studies have identified various combinations of risk factors including advanced age, higher American Society of Anesthesiologist (ASA) level, high-risk surgery, and chronic obstructive pulmonary disease (COPD). 3 -7 Unfortunately, many of these risk factors are not specific for postoperative respiratory complications and are common in poor surgical candidates.…”

mentioning

confidence: 99%

Risk Factors for Postoperative Unplanned Intubation: Analysis of a National Database

Alvarez

Samayoa-Mendez

Naglak

et al. 2015

The American Surgeon

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Postoperative unplanned intubation (PUI) is a significant complication and is associated with severe adverse events and mortality. By participating in the National Surgical Quality Improvement Program (NSQIP), we learned that PUI occurred more frequently than expected at our institution. The aim of this study was to identify risk factors that are predictors of PUI at our institution. We reviewed the NSQIP data from our institution and the NSQIP national database for surgery patients from 2010 through 2013. The rate of PUI at our institution was 1.54 per cent compared with the national rate of 1.03 per cent. Perioperative risk factors were analyzed by multivariate logistic regression. Analysis of the national NSQIP database identified 14 independent risk factors for PUI. Analysis of the NSQIP data at our institution demonstrated that emergent cases, preoperative ventilator status, smoking, chronic obstructive pulmonary disease, and older age were independent risk factors. In conclusion, patients at our institution with these five risk factors were at higher risk of requiring PUI. These risk factors could be used to help identify patients at high risk and possibly help prevent postoperative respiratory failure and unplanned intubation.

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Unplanned intubation: When and why does this deadly complication occur?

Cited by 15 publications

References 24 publications

The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury

The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury

Patient-specific predictors of failure to rescue after pancreaticoduodenectomy

Risk Factors for Postoperative Unplanned Intubation: Analysis of a National Database

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