INDEPENDENT EFFECTS OF ETIOLOGY OF FAILURE AND TIME TO REINTUBATION ON OUTCOME FOR PATIENTS FAILING EXTUBATION

Patients requiring reintubation after failed extubation have a poor pr ognosis, with hospital mortality exceeding 30 to 40%, though the reaso n remains unclear. To examine the impact of etiology of extubation fai lure and time to reintubation on hospital outcome, we performed a post hoc analysis of prospectively gathered data on 74 MICU patients (47 m en, 27 women), 64 +/- 2 yr of age who required reintubation within 72 h of extubation. Cause for reintubation was classified as airway (uppe r airway obstruction, 11; aspiration/excess pulmonary secretions, 12) or nonairway (respiratory failure, 21; congestive heart failure, 17; e ncephalopathy, 7; other, 6). The duration of mechanical ventilation pr ior to extubation was 139 +/- 19 h, and the median time to reintubatio n was 21 h. Thirty-one of 74 patients (42%) died, with mortality highe st for patients failing from nonairway etiologies (27/51, 53% versus 4 /23, 17%; p < 0.01). Patients failing from an airway cause tended to b e reintubated earlier (21 +/- 4 versus 31 +/- 3 h, p = 0.07). Mortalit y increased with longer duration of time from extubation to reintubati on (less than or equal to 12 h, 6/25 versus > 12 h, 25/49; p < 0.05). With multiple logistic regression, both cause for extubation failure a nd time to reintubation were independently associated with hospital mo rtality. In conclusion, etiology of extubation failure and time to rei ntubation are independent predictors of outcome in reintubated MICU pa tients. The high mortality for those reintubated for nonairway problem s indicate that efforts should be preferentially focused on identifyin g these patients. The effect of time to reintubation suggests that ide ntification of patients early after extubation and timely reinstitutio n of ventilatory support has the potential to reduce the increased mor tality associated with extubation failure.