Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Intensive Care, University of Fukui Hospital, Yoshida, Fukui, Japan.
Crit Care. 2023 Sep 30;27(1):378. doi: 10.1186/s13054-023-04668-3.
Reintubation is a common complication in critically ill patients requiring mechanical ventilation. Although reintubation has been demonstrated to be associated with patient outcomes, its time definition varies widely among guidelines and in the literature. This study aimed to determine the association between reintubation and patient outcomes as well as the consequences of the time elapsed between extubation and reintubation on patient outcomes.
This was a multicenter retrospective cohort study of critically ill patients conducted between April 2015 and March 2021. Adult patients who underwent mechanical ventilation and extubation in intensive care units (ICUs) were investigated utilizing the Japanese Intensive Care PAtient Database. The primary and secondary outcomes were in-hospital and ICU mortality. The association between reintubation and clinical outcomes was studied using Cox proportional hazards analysis. Among the patients who underwent reintubation, a Cox proportional hazard analysis was conducted to evaluate patient outcomes according to the number of days from extubation to reintubation.
Overall, 184,705 patients in 75 ICUs were screened, and 1849 patients underwent reintubation among 48,082 extubated patients. After adjustment for potential confounders, multivariable analysis revealed a significant association between reintubation and increased in-hospital and ICU mortality (adjusted hazard ratio [HR] 1.520, 95% confidence interval [CI] 1.359-1.700, and adjusted HR 1.325, 95% CI 1.076-1.633, respectively). Among the reintubated patients, 1037 (56.1%) were reintubated within 24 h after extubation, 418 (22.6%) at 24-48 h, 198 (10.7%) at 48-72 h, 111 (6.0%) at 72-96 h, and 85 (4.6%) at 96-120 h. Multivariable Cox proportional hazard analysis showed that in-hospital and ICU mortality was highest in patients reintubated at 72-96 h (adjusted HR 1.528, 95% CI 1.062-2.197, and adjusted HR 1.334, 95% CI 0.756-2.352, respectively; referenced to reintubation within 24 h).
Reintubation was associated with a significant increase in in-hospital and ICU mortality. The highest mortality rates were observed in patients who were reintubated between 72 and 96 h after extubation. Further studies are warranted for the optimal observation of extubated patients in clinical practice and to strengthen the evidence for mechanical ventilation.
重新插管是机械通气的危重症患者常见的并发症。尽管重新插管与患者预后相关已得到证实，但指南和文献中对其时间定义差异很大。本研究旨在确定重新插管与患者预后之间的关联，以及拔管至重新插管之间的时间间隔对患者预后的影响。
这是一项 2015 年 4 月至 2021 年 3 月期间在多个中心进行的、针对危重症患者的回顾性队列研究。使用日本重症监护患者数据库，对在重症监护病房（ICU）中接受机械通气和拔管的成年患者进行了调查。主要和次要结局是院内和 ICU 死亡率。使用 Cox 比例风险分析研究重新插管与临床结局之间的关联。在接受重新插管的患者中，根据拔管至重新插管的天数进行 Cox 比例风险分析，以评估患者的预后。
在筛选了 75 个 ICU 中的 184705 名患者后，在 48082 名拔管患者中，有 1849 名患者接受了重新插管。在调整了潜在混杂因素后，多变量分析显示，重新插管与院内和 ICU 死亡率增加显著相关（调整后的危险比[HR] 1.520，95%置信区间[CI] 1.359-1.700 和调整后的 HR 1.325，95% CI 1.076-1.633）。在重新插管的患者中，1037 例（56.1%）在拔管后 24 小时内再次插管，418 例（22.6%）在 24-48 小时内，198 例（10.7%）在 48-72 小时内，111 例（6.0%）在 72-96 小时内，85 例（4.6%）在 96-120 小时内。多变量 Cox 比例风险分析显示，在拔管后 72-96 小时再次插管的患者中，院内和 ICU 死亡率最高（调整后的 HR 1.528，95% CI 1.062-2.197 和调整后的 HR 1.334，95% CI 0.756-2.352，分别与 24 小时内再次插管相比）。
重新插管与院内和 ICU 死亡率显著增加相关。在拔管后 72-96 小时再次插管的患者中，死亡率最高。需要进一步研究，以优化临床实践中对拔管患者的观察，并加强机械通气的证据。
