Predictors of re-intubation in trauma intensive care unit: Qatar experience

Saeed Mahmood, Mushrek Alani, Hassan Al-Thani, Ismail Mahmood, Ayman El-Menyar, Rifat - Latifi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: To determine the causes, predictors and outcomes of reintubation. Methods: Retrospective analysis of data collected from the trauma data base registry was conducted to identify the extubation failure cases in Trauma ICU at Hamad General Hospital, the only Level I trauma center in Qatar between January 2009 and December 2010. Demographics, mechanism of Injury, complications, injury severity score (ISS), Glasgow Coma Scale (GCS), ICU-length of stay (LOS), and mortality were analyzed among trauma patients who need reintubation within 48 hrs after extubation (group 1) compared to successfully extubated patients (group 2). Result: A total of 954 patients were admitted to the trauma ICU, of which 343 were intubated orotracheally. The mean age of patients was 32±12 years with male predominance (95%). Motor vehicle crash (41%), pedestrian injury (20%) and falls (18%) were the most common mechanisms of injury. Reintubation (group 1) was required in 24 patients (7%). Patients in group 1 had higher rate of head injury mainly SAH (88%), pneumonia (79%) and pulmonary contusion (58%). The mean ICU-LOS was higher in the reintubated patients (p=0.010) in comparison to group 2. Forty-six percent of reintubated patients required tracheostomy. The mean age, ISS, GCS and tube size was comparable among the two groups. Furthermore, reintubation was not associated with higher mortality rate (p=0.910). However, Ventilator-associated pneumonia (VAP) (odd ratio=3.61 [95% CI 1.25-10.44]; p=0.020) and ventilator days (odd ratio=1.09 [95% CI 1.024-1.153]; p=0.006) were independent predictors of reintubation by multivariate analysis. Conclusion: Re-intubation is associated with increased ICU-LOS and need for tracheostomy. VAP and prolonged intubation are independent predictors of re-intubation. Our finding addresses the value of prevention and early treatment of infection in intubated patients. This study may represent an audit of local practice as well.

Original languageEnglish (US)
Pages (from-to)289-293
Number of pages5
JournalOman Medical Journal
Volume29
Issue number4
DOIs
StatePublished - 2014

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Qatar
Intubation
Intensive Care Units
Wounds and Injuries
Ventilator-Associated Pneumonia
Length of Stay
Glasgow Coma Scale
Injury Severity Score
Tracheostomy
Odds Ratio
Mortality
Contusions
Trauma Centers
Motor Vehicles
Mechanical Ventilators
Craniocerebral Trauma
General Hospitals
Registries
Pneumonia
Multivariate Analysis

Keywords

  • Failed extubation
  • Intensive care unit
  • Re-intubation
  • Tracheostomy
  • Trauma

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Predictors of re-intubation in trauma intensive care unit : Qatar experience. / Mahmood, Saeed; Alani, Mushrek; Al-Thani, Hassan; Mahmood, Ismail; El-Menyar, Ayman; Latifi, Rifat -.

In: Oman Medical Journal, Vol. 29, No. 4, 2014, p. 289-293.

Research output: Contribution to journalArticle

Mahmood, S, Alani, M, Al-Thani, H, Mahmood, I, El-Menyar, A & Latifi, R 2014, 'Predictors of re-intubation in trauma intensive care unit: Qatar experience', Oman Medical Journal, vol. 29, no. 4, pp. 289-293. https://doi.org/10.5001/omj.2014.75
Mahmood, Saeed ; Alani, Mushrek ; Al-Thani, Hassan ; Mahmood, Ismail ; El-Menyar, Ayman ; Latifi, Rifat -. / Predictors of re-intubation in trauma intensive care unit : Qatar experience. In: Oman Medical Journal. 2014 ; Vol. 29, No. 4. pp. 289-293.
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abstract = "Objectives: To determine the causes, predictors and outcomes of reintubation. Methods: Retrospective analysis of data collected from the trauma data base registry was conducted to identify the extubation failure cases in Trauma ICU at Hamad General Hospital, the only Level I trauma center in Qatar between January 2009 and December 2010. Demographics, mechanism of Injury, complications, injury severity score (ISS), Glasgow Coma Scale (GCS), ICU-length of stay (LOS), and mortality were analyzed among trauma patients who need reintubation within 48 hrs after extubation (group 1) compared to successfully extubated patients (group 2). Result: A total of 954 patients were admitted to the trauma ICU, of which 343 were intubated orotracheally. The mean age of patients was 32±12 years with male predominance (95{\%}). Motor vehicle crash (41{\%}), pedestrian injury (20{\%}) and falls (18{\%}) were the most common mechanisms of injury. Reintubation (group 1) was required in 24 patients (7{\%}). Patients in group 1 had higher rate of head injury mainly SAH (88{\%}), pneumonia (79{\%}) and pulmonary contusion (58{\%}). The mean ICU-LOS was higher in the reintubated patients (p=0.010) in comparison to group 2. Forty-six percent of reintubated patients required tracheostomy. The mean age, ISS, GCS and tube size was comparable among the two groups. Furthermore, reintubation was not associated with higher mortality rate (p=0.910). However, Ventilator-associated pneumonia (VAP) (odd ratio=3.61 [95{\%} CI 1.25-10.44]; p=0.020) and ventilator days (odd ratio=1.09 [95{\%} CI 1.024-1.153]; p=0.006) were independent predictors of reintubation by multivariate analysis. Conclusion: Re-intubation is associated with increased ICU-LOS and need for tracheostomy. VAP and prolonged intubation are independent predictors of re-intubation. Our finding addresses the value of prevention and early treatment of infection in intubated patients. This study may represent an audit of local practice as well.",
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AU - Mahmood, Ismail

AU - El-Menyar, Ayman

AU - Latifi, Rifat -

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N2 - Objectives: To determine the causes, predictors and outcomes of reintubation. Methods: Retrospective analysis of data collected from the trauma data base registry was conducted to identify the extubation failure cases in Trauma ICU at Hamad General Hospital, the only Level I trauma center in Qatar between January 2009 and December 2010. Demographics, mechanism of Injury, complications, injury severity score (ISS), Glasgow Coma Scale (GCS), ICU-length of stay (LOS), and mortality were analyzed among trauma patients who need reintubation within 48 hrs after extubation (group 1) compared to successfully extubated patients (group 2). Result: A total of 954 patients were admitted to the trauma ICU, of which 343 were intubated orotracheally. The mean age of patients was 32±12 years with male predominance (95%). Motor vehicle crash (41%), pedestrian injury (20%) and falls (18%) were the most common mechanisms of injury. Reintubation (group 1) was required in 24 patients (7%). Patients in group 1 had higher rate of head injury mainly SAH (88%), pneumonia (79%) and pulmonary contusion (58%). The mean ICU-LOS was higher in the reintubated patients (p=0.010) in comparison to group 2. Forty-six percent of reintubated patients required tracheostomy. The mean age, ISS, GCS and tube size was comparable among the two groups. Furthermore, reintubation was not associated with higher mortality rate (p=0.910). However, Ventilator-associated pneumonia (VAP) (odd ratio=3.61 [95% CI 1.25-10.44]; p=0.020) and ventilator days (odd ratio=1.09 [95% CI 1.024-1.153]; p=0.006) were independent predictors of reintubation by multivariate analysis. Conclusion: Re-intubation is associated with increased ICU-LOS and need for tracheostomy. VAP and prolonged intubation are independent predictors of re-intubation. Our finding addresses the value of prevention and early treatment of infection in intubated patients. This study may represent an audit of local practice as well.

AB - Objectives: To determine the causes, predictors and outcomes of reintubation. Methods: Retrospective analysis of data collected from the trauma data base registry was conducted to identify the extubation failure cases in Trauma ICU at Hamad General Hospital, the only Level I trauma center in Qatar between January 2009 and December 2010. Demographics, mechanism of Injury, complications, injury severity score (ISS), Glasgow Coma Scale (GCS), ICU-length of stay (LOS), and mortality were analyzed among trauma patients who need reintubation within 48 hrs after extubation (group 1) compared to successfully extubated patients (group 2). Result: A total of 954 patients were admitted to the trauma ICU, of which 343 were intubated orotracheally. The mean age of patients was 32±12 years with male predominance (95%). Motor vehicle crash (41%), pedestrian injury (20%) and falls (18%) were the most common mechanisms of injury. Reintubation (group 1) was required in 24 patients (7%). Patients in group 1 had higher rate of head injury mainly SAH (88%), pneumonia (79%) and pulmonary contusion (58%). The mean ICU-LOS was higher in the reintubated patients (p=0.010) in comparison to group 2. Forty-six percent of reintubated patients required tracheostomy. The mean age, ISS, GCS and tube size was comparable among the two groups. Furthermore, reintubation was not associated with higher mortality rate (p=0.910). However, Ventilator-associated pneumonia (VAP) (odd ratio=3.61 [95% CI 1.25-10.44]; p=0.020) and ventilator days (odd ratio=1.09 [95% CI 1.024-1.153]; p=0.006) were independent predictors of reintubation by multivariate analysis. Conclusion: Re-intubation is associated with increased ICU-LOS and need for tracheostomy. VAP and prolonged intubation are independent predictors of re-intubation. Our finding addresses the value of prevention and early treatment of infection in intubated patients. This study may represent an audit of local practice as well.

KW - Failed extubation

KW - Intensive care unit

KW - Re-intubation

KW - Tracheostomy

KW - Trauma

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