FRIEND or FOE: A prospective evaluation of risk factors for reintubation in surgical and trauma patients - 06/12/18
, Margaret M. Griffen , Erik J. Teicher , Jennifer L. Rodriguez , Hani Seoudi , Chang Liu , Elena Lita , Anna Newcomb Abstract |
Background |
A Form for Re-Intubation Evaluation by Nurses and Doctors (FRIEND) was used to prospectively collect pre-extubation data, to determine failure of extubation (FOE) risk.
Methods |
FRIENDs, including airway, breathing, and neurologic variables, were completed before extubation on trauma & surgical patients in one ICU from 1/1/16 to 5/31/17. Those with failed vs. successful extubation were compared. We excluded those with tracheostomy, comfort measures, or death before extubation.
Results |
There were 464 eligible extubations in 436 patients. Thirty five reintubations (7.9% FOE rate) occurred in 32 patients within 96 h of extubation. FOE patients had higher ICU days (6 d vs. 2 d), ventilator days (6 d vs. 2 d), and mortality (15.6% vs. 2.7%) [all p < 0.001] compared to those without FOE. Odds of FOE (OR [CI]) increased with age (1.03, [1, 1.06]), delirium (3, [1.16, 7.76]), moderate/copious secretions (3.95, [1.46, 10.66]), and enteral opioid use (4.23, [1.28, 14.02]).
Conclusions |
Several characteristics present at the time of extubation were risk factors for FOE in trauma and surgical patients. Patients with FOE had higher mortality.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Reintubation may or may not relate to factors contemporaneous with extubation. |
• | Reintubation within 96 h of extubation is considered failure of extubation (FOE). |
• | Failure of extubation was associated with higher mortality, ICU and ventilator days. |
• | Risk factors for failure of extubation may be identified and potentially modified. |
Summary |
We performed a prospective study to determine risk factors for reintubation in trauma and surgical patients by collecting patient-level variables just prior to extubation using FRIEND (Form for Re-Intubation Evaluation by Nurses and Doctors). The failure of extubation (FOE) rate within 96 h of extubation was 7.3%. ICU days (6 d vs. 2 d), ventilator days (6 d vs. 2 d), and mortality (15.6% vs. 2.7%) were all greater in patients with FOE [all p < 0.001]. On multivariate analysis, odds of FOE (OR [CI]) increased with age (1.03, [1, 1.06]), delirium (3, [1.16, 7.76]), moderate/copious secretions (3.95, [1.46, 10.66]), and enteral opioid use (4.23, [1.28, 14.02]).
Le texte complet de cet article est disponible en PDF.Keywords : Reintubation, Failure of extubation, Risk factors, Extubation
Plan
| ☆ | This study was presented as an oral quickshot presentation at the 31st Annual Meeting of the Eastern Association for the Surgery of Trauma on January 10, 2018 in Orlando, FL. |
Vol 216 - N° 6
P. 1056-1062 - décembre 2018 Retour au numéro
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