Background
Methods
Study design
Data collection
Outcomes
Statistical analyses
Results
Extubation in critically ill patients
Reintubation and its timing after extubation
All (n = 1849) | Reintubation ≤ 24 h (n = 1037) | Reintubation 24–48 h (n = 418) | Reintubation 48–72 h (n = 198) | Reintubation 72–96 h (n = 111) | Reintubation 96–120 h (n = 85) | P value | |
---|---|---|---|---|---|---|---|
Age, years | 71 (60–78) | 71 (58–78) | 71 (61–79) | 73 (65–78) | 72 (65–78) | 70 (63–77) | 0.156 |
Sex, male | 1176 (63.6%) | 639 (61.6%) | 277 (66.3%) | 131 (66.2%) | 78 (70.3%) | 51 (60.0%) | 0.184 |
Body mass index, kg/m2 | 22.2 (19.5–25.1) | 22.3 (19.5–25.1) | 21.9 (19.2–24.7) | 21.9 (19.2–25.0) | 22.3 (19.9–25.2) | 22.2 (19.8–25.6) | 0.391 |
Comorbidity | |||||||
Chronic heart failure | 51 (2.8%) | 31 (3.0%) | 9 (2.2%) | 6 (3.0%) | 4 (3.6%) | 1 (1.2%) | 0.776 |
Chronic respiratory failure | 51 (2.8%) | 26 (2.5%) | 13 (3.1%) | 6 (3.0%) | 3 (2.7%) | 3 (3.5%) | 0.886 |
Chronic liver disease | 24 (1.3%) | 12 (1.2%) | 6 (1.4%) | 1 (0.5%) | 3 (2.7%) | 2 (2.4%) | 0.333 |
Malignancy | 74 (4.0%) | 42 (4.1%) | 13 (3.1%) | 7 (3.5%) | 4 (3.6%) | 8 (9.4%) | 0.166 |
Immunodeficiency | 160 (8.7%) | 74 (7.1%) | 46 (11.0%) | 20 (10.1%) | 11 (9.9%) | 9 (10.6%) | 0.131 |
Maintenance dialysis | 129 (7.0%) | 60 (5.8%) | 36 (8.6%) | 19 (9.6%) | 9 (8.1%) | 5 (5.9%) | 0.168 |
Emergency admission | 1248 (67.5%) | 726 (70.0%) | 267 (63.9%) | 120 (60.6%) | 72 (64.9%) | 63 (74.1%) | 0.019 |
Surgical type of admission | 1157 (62.6%) | 622 (60.0%) | 285 (68.2%) | 132 (66.7%) | 66 (59.5%) | 52 (61.2%) | 0.032 |
Systematic diagnosis for ICU admission | |||||||
Cardiac | 830 (44.9%) | 465 (44.8%) | 184 (44.0%) | 93 (47.0%) | 51 (45.9%) | 37 (43.5%) | 0.015 |
Respiratory | 322 (17.4%) | 191 (18.4%) | 69 (16.5%) | 30 (15.2%) | 18 (16.2%) | 14 (16.5%) | |
Gastrointestinal | 276 (14.9%) | 119 (11.5%) | 80 (19.1%) | 44 (22.2%) | 18 (16.2%) | 15 (17.6%) | |
Neurological | 224 (12.1%) | 150 (14.5%) | 44 (10.5%) | 16 (8.1%) | 9 (8.1%) | 5 (5.9%) | |
Sepsis | 36 (1.9%) | 22 (2.1%) | 7 (1.7%) | 3 (1.5%) | 1 (0.9%) | 3 (3.5%) | |
Trauma | 65 (3.5%) | 38 (3.7%) | 13 (3.1%) | 6 (3.0%) | 4 (3.6%) | 4 (4.7%) | |
Metabolic | 37 (2.0%) | 25 (2.4%) | 7 (1.7%) | 0 (0%) | 4 (3.6%) | 1 (1.2%) | |
Hematological | 14 (0.8%) | 8 (0.8%) | 1 (0.2%) | 1 (0.5%) | 2 (1.8%) | 2 (2.4%) | |
Renal/Genitourinary | 8 (0.4%) | 4 (0.4%) | 2 (0.5%) | 1 (0.5%) | 1 (0.9%) | 0 (0%) | |
Gynecological | 20 (1.1%) | 8 (0.8%) | 7 (1.7%) | 2 (1.0%) | 2 (1.8%) | 1 (1.2%) | |
Other | 17 (0.9%) | 7 (0.7%) | 4 (1.0%) | 2 (1.0%) | 1 (0.9%) | 3 (3.5%) | |
APACHE II score | 20 (16–25) | 20 (16–25) | 20 (16–25) | 20 (16–24) | 20 (16–24) | 20 (16–26) | 0.889 |
APACHE III score | 75 (61–94) | 74 (60–95) | 74 (60–94) | 75 (62–93) | 75 (64–94) | 77 (65–96) | 0.551 |
Data within 24 h after ICU admission | |||||||
Incidence of AKI | 100 (5.4%) | 49 (4.7%) | 25 (6.0%) | 10 (5.1%) | 9 (8.1%) | 7 (8.2%) | 0.328 |
PaO2:FiO2 | 282.5 (187.8–392.4) | 280.8 (183.1–388.2) | 287.8 (198.8–393.4) | 300.0 (196.3–410.6) | 259.1 (176.8–396.1) | 264.1 (185.4–353.9) | 0.436 |
GCS score < 8 | 292 (15.8%) | 193 (18.6%) | 51 (12.2%) | 19 (9.6%) | 15 (13.5%) | 14 (16.5%) | 0.002 |
All | Reintubation ≤ 24 h | Reintubation 24–48 h | Reintubation 48–72 h | Reintubation 72–96 h | Reintubation 96–120 h | P value | |
---|---|---|---|---|---|---|---|
VV–ECMO | 35 (1.9%) | 11 (1.1%) | 11 (2.6%) | 5 (2.5%) | 3 (2.7%) | 5 (5.9%) | 0.008 |
VA–ECMO | 87 (4.7%) | 47 (4.5%) | 19 (4.5%) | 5 (2.5%) | 8 (7.2%) | 8 (9.4%) | 0.096 |
Renal replacement therapy | 439 (23.7%) | 209 (20.2%) | 106 (25.4%) | 59 (29.8%) | 40 (36.0%) | 25 (29.4%) | < 0.001 |
Noninvasive respiratory support | 768 (41.5%) | 384 (37.0%) | 196 (46.9%) | 86 (43.4%) | 56 (50.5%) | 46 (54.1%) | < 0.001 |
Duration of first mechanical ventilation, h | 56.1 (17.5–130.3) | 54.8 (17.2–127.6) | 44.0 (17.1–116.2) | 55.7 (17.4–118.1) | 66.6 (22.5–145.8) | 94.2 (37.3–185.2) | < 0.001 |
Hours from extubation to reintubation, h | 19.3 (4.7–43.0) | 5.8 (1.8–11.9) | 31.5 (27.2–39.1) | 56.8 (51.4–66.4) | 80.1 (75.9–88.9) | 104.8 (99.7–114.4) | < 0.001 |
Total duration of mechanical ventilation, h | 191.4 (99.8–334.1) | 178.3 (97.4–314.9) | 191.0 (88.8–349.4) | 226.4 (103.6–386.6) | 232.4 (126.8–372.7) | 259.7 (125.9–463.2) | < 0.001 |
Number of reintubation episodes | 1 (1–1) | 1 (1–1) | 1 (1–1) | 1 (1–1) | 1 (1–1) | 1 (1–1) | 0.137 |
Tracheostomy during ICU stay | 614 (33.2%) | 318 (30.7%) | 154 (36.8%) | 68 (34.3%) | 45 (40.5%) | 29 (34.1%) | 0.078 |
Length of ICU stay, days | 8 (5–14) | 7 (4–12) | 9 (6–15) | 11 (7–17.75) | 12 (8–18.5) | 14 (10–19) | < 0.001 |
Length of hospital stay, days | 40 (23–68) | 36 (21–61) | 45 (25–73) | 44 (27–68) | 43 (25–80) | 60 (36–96) | < 0.001 |
Timing of reintubation and patient outcomes
Reintubation ≤ 24 h | Reintubation 24–48 h | Reintubation 48–72 h | Reintubation 72–96 h | Reintubation 96–120 h | |
---|---|---|---|---|---|
ICU mortality | |||||
N (person-day) | 74 (10,562) | 38 (5540) | 18 (2848) | 15 (1692) | 12 (1804) |
Crude HR (95% CI) | 1 (reference) | 0.964 (0.651–1.428) | 0.906 (0.540–1.519) | 1.293 (0.741–2.256) | 0.861 (0.462–1.604) |
Adjusted HR (95% CI) * | 1 (reference) | 0.915 (0.610–1.371) | 0.991 (0.587–1.672) | 1.334 (0.756–2.352) | 0.833 (0.444–1.561) |
In-hospital mortality | |||||
N (person-day) | 183 (50,024) | 96 (22,692) | 53 (10,674) | 35 (6467) | 27 (5968) |
Crude HR (95% CI) | 1 (reference) | 1.187 (0.9268–1.520) | 1.385 (1.020–1.880) | 1.524 (1.061–2.189) | 1.303 (0.869–1.954) |
Adjusted HR (95% CI) * | 1 (reference) | 1.154 (0.898–1.485) | 1.283 (0.940–1.751) | 1.528 (1.062–2.197) | 1.179 (0.783–1.777) |