TY - JOUR T1 - Predictors of Re-intubation in Critically Ill Patients JF - Respiratory Care DO - 10.4187/respcare.02527 SP - respcare.02527 AU - Timothy Miu AU - Aaron M. Joffe AU - N. David Yanez AU - Nita Khandelwal AU - Armagan HC Dagal AU - Steven Deem AU - Miriam M. Treggiari Y1 - 2013/07/16 UR - http://rc.rcjournal.com/content/early/2013/07/16/respcare.02527.abstract N2 - Background: Assessment of patient’s readiness for removal of the endotracheal tube in the Intensive Care Unit (ICU) is based on respiratory, airway and neurological measures. However, nearly 20% of patients require reintubation. We aimed to generate a prediction model for the need of reintubation that incorporates variables importantly contributing to extubation failure. Methods: Cohort study of 2,007 endotracheally intubated patients who required ICU admission at a single tertiary care center. Data collection included: demographic, hemodynamic, respiratory and neurological variables preceding extubation. Data were compared between patients extubated successfully and those who required reintubation using bivariate logistic regression models with the binary outcome reintubation and the baseline characteristics as predictors. Multivariable logistic regression analysis with robust variance was used to build the prediction model. Results: Of 2,007 patients analyzed, 376 (19%) required reintubation. In bivariate analysis, admission SAPS-II, minute ventilation, respiratory rate, oxygenation, number of prior SBTs, rapid-shallow breathing index, secretion frequency and quantity, heart rate, and diastolic blood pressure differed significantly between the extubation success and failure groups. In multivariable analysis, higher SAPS-II and suction frequency, were associated with failed extubation. The areas under the receiving operator curve were 0.68 for failure at any time and 0.71 for failure within 24 hours model. However, prior failed SBTs, minute ventilation and diastolic blood pressure were additional independent predictors of failure at any time, while oxygenation predicted extubation failure within 24 hours. Conclusions: A small number of independent variables explained a substantial portion of variability of extubation failure and can help identify with accuracy patients at high risk of needing reintubation. These characteristics should be incorporated in the decision-making process of ICU extubation. ER -