| Unplanned reintubation following extubation failure is a significant complication in critically ill trauma
patients, leading to increased morbidity, prolonged hospital stays, and higher mortality rates. Identifying risk factors
associated with extubation failure can help improve patient outcomes and optimize extubation readiness assessment.
Methods: This retrospective study was conducted at a Level-I trauma center from January 2017 to December 2017. Adult
trauma patients who were extubated from invasive mechanical ventilation via an oral endotracheal tube were included.
Patients with advanced directives restricting treatment, pre-extubation tracheostomy, self-extubation, or those who died
prior to extubation were excluded. The primary outcome was unplanned reintubation within 96 hours of extubation. Data
were analyzed using bivariate and multivariable logistic regression analyses to identify independent predictors of
reintubation. Results: A total of 790 patients were screened, with 439 patients meeting the inclusion criteria. Of these, 47
(10.7%) required unplanned reintubation within 96 hours, and 71 (16.1%) required reintubation at some point during
hospitalization. Patients who required unplanned reintubation were older (median: 57±21.5 vs. 49±19.8 years, p=0.012)
and had higher rates of comorbidities such as end-stage renal disease (8.7% vs. 2.6%, p=0.044), congestive heart failure
(13.3% vs. 1.8%, p<0.001), and cirrhosis (8.7% vs. 2.9%, p=0.025). They also had higher ISS (median: 37±9.4 vs.
17±12.5, p<0.001) and head AIS (median: 4±2 vs. 2±2, p=0.004). Additionally, lower serum hemoglobin (median: 7.2±1.6
vs. 11.3±2.2 g/dL, p<0.001), increased atelectasis on chest radiographs (83.6% vs. 58.6%, p=0.001), and more ventilator
days before initial extubation (median: 7±4.5 vs. 4±3.5, p<0.001) were observed in reintubated patients.Multivariable
logistic regression analysis identified ISS (OR 1.04, CI 1.01-1.07, p=0.022) and increasing age (OR 1.05, CI 1.02-1.07,
p=0.006) as independent predictors of unplanned reintubation. Patients who required unplanned reintubation had longer
hospital stays (median: 28±17.2 vs. 12±15.1 days, p<0.001), longer ICU stays (median: 19±8.8 vs. 3±5.9 days, p<0.001),
and higher rates of sepsis (16.4% vs. 2.1%, p<0.001), acute kidney injury (19.4% vs. 3.5%, p<0.001), and central lineassociated bloodstream infections (12.3% vs. 0.3%, p<0.001). Mortality was significantly higher in reintubated patients
(10.3% vs. 0%, p<0.001). Conclusion: Unplanned reintubation in trauma patients is associated with increased morbidity
and mortality. Older age, higher ISS, prolonged mechanical ventilation, lower hemoglobin levels, and radiographic
evidence of atelectasis are significant risk factors. Identifying high-risk patients before extubation and implementing
targeted interventions may reduce the incidence of extubation failure and improve patient outcomesddd |
