886: Extubation Outcomes: Calculated Risk or Luck of the Draw?

Abstract

INTRODUCTION:Prolonged mechanical ventilation is associated with longer hospitalization and higher mortality rates. Minimizing intubation duration is key in preventing such complications. Many factors have been assessed to predict the outcome of extubation, including Rapid Shallow Breathing Index (RSBI), Spontaneous Breathing Trial, and cough strength but 10-29% of patients who met these criteria still experience reintubation. Although there are no clear definitions of extubation failure, generally it is defined as required reintubation within 48 hours of a planned extubation. This study aims to address the extubation failure rate at Louisiana State University Health Shreveport hospital and provide insight on what patient characteristics were associated with failed extubation outcomes. METHODS:A retrospective observational cohort study of intubated patients from 7/2020 -4/2022 was conducted. Patient characteristics, hospitalization duration, reason for reintubation, oxygen requirements and disposition were recorded. RESULTS:A total of 725 patients were intubated during the study. The most common indication for intubation was airway protection, surgical intervention and respiratory distress. Twenty-eight patients required reintubation in less than 48 hours and met our criteria for extubation failure. The reintubation rate was 3.8%. Approximately 54% of patients were male with average age of 62 years old. Average time to extubation failure was less than 24 hours. Average RSBI prior to extubation was reported as 59.75 with 8% of patients having a successful T-piece trial. The main cause of reintubation was airway protection. Out of the 28 subjects, 12 underwent tracheostomy after reintubation. The mortality rate in this study was 14% among patients who had extubation failure. CONCLUSIONS:Extubation failure is associated with an increase in the duration of mechanical ventilation, greater need for tracheostomy and higher mortality rate. Average reintubation rate or extubation failure rate is 10-20%. Lack of standardized practice for predicting extubation outcomes or standardized definitions of extubation failure puts patients at risk of intubation complications and death. Multicentered prospective studies are required for the development of standardized extubation practices to improve patient outcomes.