Postoperative reintubation after planned extubation: A review of 137,866 general anesthetics from 2005 to 2007 in a Medical Center of Taiwan

Ting, Pei‐Chi; Chou, An‐Hsun; Yang, Min-Wen; Ho, Angie Chi-Yueh; Chang, Ching‐Jui; Chang, Shu‐Chen

doi:10.1016/j.aat.2010.12.003

Cited by 24 publications

(24 citation statements)

References 19 publications

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“…13 19 Patients with chronic pulmonary disease had a significantly higher risk for reintubation, a result similarly found in three previous studies. 18 20 21 Our results are comparable with previous studies in that preoperative renal insufficiency and hypoalbuminaemia are significant independent risk factors for reintubation. 21 22 Renal insufficiency may result in impaired excretion of anaesthetic agents which would prolong the duration of the drugs, while hypoalbuminaemia reflects poor metabolic reserve.…”

Section: Discussionsupporting

confidence: 88%

Risk factors for reintubation in the post-anaesthetic care unit: a case–control study

Rujirojindakul

Geater

McNeil

et al. 2012

British Journal of Anaesthesia

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Editor's key points † This study investigates the risk factors for reintubation in post-anaesthetic care units related to anaesthetic processes. † Risk factors were age ,1 yr, chronic pulmonary disease, preoperative hypoalbuminaemia and renal insufficiency, head and neck surgery, airway surgery, cardiothoracic surgery, cardiac catheterization, emergency case, duration of operation more than 3 h, ASA physical status III, and the use of certain neuromuscular blocking agents. Background. Risk factors for reintubation in post-anaesthetic care units related to anaesthetic processes have not previously been reported. Our goal was to identify risk factors for reintubation in general surgical patients. Methods. A time-matched, case-control study was conducted on anaesthetic patients between 2001 and 2011. One hundred and sixty-four reintubated patients were compared with 656 randomly selected controls. Results. Independent risk factors for reintubation were age ,1 yr vs age 30-49 yr [odds ratio (OR)¼16.4, 95% confidence interval (CI)¼5.7-47.7], chronic pulmonary disease (OR¼2.1, CI¼1.1-4.0), preoperative hypoalbuminaemia (OR¼4.9, CI¼2.4 -10), creatinine clearance ,24 vs .60 (OR¼4.1, CI¼1.2-13.4), emergency case (OR¼1.8, CI¼1.0-3.1), operative time .3 vs ,1 h (OR¼3.0, CI¼1.5 -6.2), airway surgery (OR¼32.2, CI¼13.6 -76), head and neck surgery (OR¼3.4, CI¼1.8 -6.2), cardiac surgery (OR¼3.8, CI¼1.1 -13.4), thoracic surgery (OR¼6.3, CI¼1.9-21.2), cardiac catheterization (OR¼2.5, CI¼1.1 -5.5), ASA physical status III (OR¼3.8, CI¼1.4-10), and the use of certain types of neuromuscular blocking agent (P,0.001). Conclusions. Age ,1 yr, chronic pulmonary disease, preoperative hypoalbuminaemia, and renal insufficiency were patient factors for reintubation. Emergency case, head and neck, cardiothoracic and airway surgery, and operative time .3 h were operative factors, while certain neuromuscular blocking agents and ASA physical status III were anaesthetic factors for reintubation. ParticipantsThe anaesthetic database included all patients who were serviced by anaesthetists either inside or outside the operating theatres. The database consisted of two parts. The first part contained preoperative data and intraoperative data which were entered into the database upon admission to the PACU by the anaesthetists involved in the patient's intraoperative care. The second part consisted of postoperative

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Section: Discussionsupporting

confidence: 88%

Risk factors for reintubation in the post-anaesthetic care unit: a case–control study

Rujirojindakul

Geater

McNeil

et al. 2012

British Journal of Anaesthesia

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“…Similarly, in our previous study involving hospitalized medical (non-surgical) patients, hypotension, decreased SpO 2 , and an abnormal respiratory rate were the most frequent pre-arrest alarm triggers. 10,21 In our hospital, the automatic electronic dashboard system (BESTboardÒ) is refreshed every five minutes, but for most of the postoperative patients recovered in the general ward, vital signs were obtained intermittently at four to eight-hour intervals. While it seems reasonable to assume that more frequent monitoring of vital signs would result in a greater decrease in the incidence of CPA, there is some evidence to suggest that this may not be the case.…”

Section: Discussionmentioning

confidence: 99%

A rapid response system reduces the incidence of in-hospital postoperative cardiopulmonary arrest: a retrospective study

Kim

Lee

et al. 2018

Can J Anesth/J Can Anesth

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“…The most widely accepted anesthetic method is general anesthesia, endotracheal intubation and controlled mechanical ventilation. Patients are usually extubated after the operation; however, some patients' need for ventilatory support continue during the postoperative period [5]. Its incidence being 1-5% [6,7], prolonged mechanical ventilation is associated with increased morbidity, long hospital stays and late mortality [3,4].…”

Section: Discussionmentioning

confidence: 99%

Extubation failure in operating room: Review of management in 50 patients at a single center

Yanaral¹

2019

Journal of Surgery and Medicine

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Aim: Postoperative extubation failure is a serious complication of general anesthesia. Prolonged mechanical ventilation is associated with increased morbidity and late mortality. There are numerous factors affecting postoperative extubation failure. In our study, we aimed to evaluate these factors. Methods: This retrospective cohort study was conducted on 50 patients who could not be extubated postoperatively between January 2016 and January 2019 in Medipol University Medical Faculty Hospital. Results: The mean age was 61.2 (6.4) (50-77) years. 29 (58%) patients were male and 21 (42%) were female. The mean Body Mass Index was 29.3 (3.6) (12-36) kilogram/square meters (kg/m 2). Mean duration of surgery was 240 (27.6) minutes. 39 (78%) patients had chronic obstructive pulmonary disease and 13 (26%) had congestive heart failure. Perioperative oxygen saturation was ≤95% in 44 (88%) patients and >95% in 6 (12%) patients. Conclusions: Chronic obstructive pulmonary diseases, congestive heart failure and low perioperative oxygen saturation are commonly seen in patients who could not be weaned from mechanical ventilation postoperatively. We advise watching out for patients with these risk factors.

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Postoperative reintubation after planned extubation: A review of 137,866 general anesthetics from 2005 to 2007 in a Medical Center of Taiwan

Abstract: risk factors for RAP are clear and unambiguous. This study will prompt further studies on preventative measures or evaluation of how to improve outcome.

Cited by 24 publications

References 19 publications

Risk factors for reintubation in the post-anaesthetic care unit: a case–control study

Risk factors for reintubation in the post-anaesthetic care unit: a case–control study

A rapid response system reduces the incidence of in-hospital postoperative cardiopulmonary arrest: a retrospective study

Extubation failure in operating room: Review of management in 50 patients at a single center

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