Reintubation as an outcome predictor in trauma patients.

Abstract

STUDY OBJECTIVE: Determine reintubation rate, identify its cause, and detail adverse outcomes from reintubation. DESIGN: Retrospective review of extubation failures in the trauma ICU. SETTING: University hospital and regional trauma center. PATIENTS: Four hundred five patients arriving intubated or requiring intubation during hospitalization after 2,516 traumatic injury admissions over 18 months. INTERVENTIONS: None. RESULTS: Reintubation incidence was 7% (27 times per 405 patients). Comparative mortality of the reintubated group (2/24 = 8%) is similar to overall trauma center mortality (224/2516 = 6.5%), but less than the cohort of patients admitted to the hospital intubated (63/405 = 16%). Reintubated patients had an increased frequency of stridor than reported previously (33%), and an increased tracheostomy rate (62% vs 30%). Stridor was not predictable from injury severity score, Glasgow coma score, age, sex, length of intubation, or place of intubation. Pulmonary complications (atelectasis, tracheobronchitis, pneumonia) developed in half of reintubated patients; stridorous patients did not have an increased rate of pulmonary complications. CONCLUSION: Reintubation in trauma ICU patients does not predict poor outcome.