Reintubation Rate and Mortality After Emergent Airway Management Outside the Operating Room

Abstract

Background Little is known about reintubations that are performed outside of the operating room (outside-OR). Reintubation in general does not occur without risk and is associated with prolonged mechanical ventilation, higher incidence of nosocomial pneumonia, increased morbidity, mortality, and care of cost. The objective of this study was to evaluate the reintubation rate and mortality after emergent airway management outside-OR, including ICU and non-ICU settings. Methods A retrospectives cohort study design was used to review all emergent airway management outside-OR. The primary outcome measures were reintubation rate and mortality. Secondary outcome measures were demographics, location of intubation, indication for intubation, time until reintubation, total intubated days, ICU-stay, hospital stay, 30-day in-hospital mortality, and overall in-hospital mortality. Results A total of 336 outside-OR intubations were performed in 275 patients. Of those 275 patients, 51 (18.5%) were reintubated during the same hospital admission. Of the 336 performed intubations, 61 (18.1%) were reintubations. There was no statistical difference in admission demographics and comorbidities among reintubated and non-reintubated patients. Reintubations occurred after up to 30-days after extubation, including within 24-hours (8.2%, n=5), 24-72 hours (27.9%, n=17), 3-7 days, (23%, n=14), and 7-30 days after extubation (32.8%, n=20). Most of the reintubated patients were reintubated just once (56.9%; n=29), but some were reintubated two times (29.4%; n=15) or three times or more (13.7%; n=7). Reintubated patients had significant longer total ICU-stay (24±3 days vs. 12±1 day, p <0.001), hospital stay (37±3 vs.18±1, p<0.001), and total intubation days (8±1 vs. 7±0.6, p<0.02) than non-reintubated patients. The 30-day in-hospital mortality in reintubated patients was 13.7% (n=7) compared to non-reintubated patients 35.9% (n=80; p=0.002). Conclusion The reintubation rate was high, reaching 18%, in intubations performed outside-OR and is associated with a significant increase in hospital and ICU-stay. Almost half of the reintubation occurred in a non-ICU setting and more than 72-hours after extubation. The higher mortality rate among non-reintubated patients may indicate survival bias, in that severely sick patients did not survive long enough to attempt extubation. Further research is needed to identify the causes for increased reintubation outside-OR and the difference in mortality between the two groups.