Causes and risk factors of reintubation in Shahid Madani cardiac surgery ICU during 2012-2013

Abstract

Abstract

Background: Extubation failure rate is one of the criteria for assessing the quality of care in intensive care unit (ICU) and higher or lower extubation failure rates indicate longer mechanical ventilation or inappropriate weaning criteria of patients, respectively. The aim of the present study was to evaluate the rate and causes of extubation failure in the cardiac surgery ICU of Tabriz Shahid Madani hospital during 2012-2013. Methods: In a cross-sectional study during 2012-2013, all intubated adult patients (over 18 years old) after cardiac surgery admitted to ICU who were re-intubated within 72 hours after extubation were studied. Results: Overall, 31 patients had the inclusion criteria. Extubation failure rate during one year was 2.45%. Extubation failure causes were hypoxemia, cardiopulmonary arrest, sepsis, acute renal failure, re-operation, shock, acute respiratory distress syndrome, pneumonia, seizures, decreased level of consciousness, copious secretion, and severe agitation. Re-intubation risk factors included chronic obstructive pulmonary disease, diabetes mellitus, renal failure, heart failure, ARDS, pneumonia, intra-aortic balloon pump, acute coronary syndrome and shock. The mean duration of mechanical ventilation before extubation was 2.3±3.1 days. The overall mortality rate of studied patients was 26% with coronary artery bypass grafting surgery as the most common cause.

Conclusions: During 2012 and 2013, the extubation failure rate in the cardiac surgery ICU was 2.45%. The most common causes of extubation failure in this setting were hypoxemia and pneumonia. Moreover, the most common risk factors for re-intubation were diabetes mellitus and renal failure.

Keywords: Airway Extubation failure; Cardiac surgery; ICU;