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Endotracheal Reintubation: A Closer Look at a Preventable Condition

Crimlisk, Janet T. M.S., R.N., C.S.; Bernardo, John M.D.; Blansfield, Joseph S. M.S., R.N., C.S., C.E.N.; Loughlin, Mary B.S.N., R.N., C.C.R.N.; McGonagle, Eileen G. B.S., R.N., C.C.R.N.; McEachern, Geraldine M.B.A., R.N.; Roeber, James M.S.P.H.; Farber, Harrison W. M.D.

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Abstract

We designed a prospective study of endotracheal intubations and reintubations in our inner city Level 1 Trauma Center, to determine the frequency and causes of reintubation and evaluate the impact of an educational intervention aimed at minimizing unplanned extubations (UEs). After an initial 3-month phase, efforts were instituted to educate healthcare providers to the causes of reintubation noted. An identical 3-month period was then studied to evaluate the efficacy of the interventions. There were 862 patients, all adults, in the initial phase of the study, with 40 reintubation events in 22 patients; of the 808 in the second phase, there were 16 reintubations in 13 patients. The reintubation rate decreased from 4.4% to 1.9% (p = 0.005). Reintubations after UEs decreased from 14% to 5.2% (rate ratio, 0.374; 95% confidence interval = 0.141, 0.990). Multiple reintubation events decreased from 45% to 18.8% (p = 0.07). Increased provider education and protocol changes were associated with lower reintubation rates.

Author Information

JANET CRIMLISK is a pulmonary CNS at Boston Medical Center (formerly Boston City Hospital) and has been active in the field of pulmonary nursing and nursing research.

JOHN BERNARDO is the director of the Pulmonary and Tuberculosis Clinic and chief of the Allergy Unit at Boston Medical Center.

HARRISON FARBER is the medical director of the MICU and director of the Respiratory Care Department at Boston Medical Center.

JOE BLANSFIELD is the trauma coordinator at Boston Medical Center and was the Emergency Department CNS at the time of the study.

MARY LOUGHLIN was the head nurse of the Surgical ICU during the study and has practiced for 20 years in critical care nursing.

EILEEN McGONAGLE was the head nurse of the MICU during the study and has been in critical care nursing for 15 years.

GERALDINE McEACHERN was head nurse of the CCU/PCU at the time of the study, with seven years in critical care nursing.

JIM ROEBER was the associate director for epidemiology and data coordination for the Office of Vital Statistics. Department of Health and Hospitals, Boston, and a consultant involved in health data and the epidemiology of intentional injury during the study.

Presented in part at the American Thoracic Society Meeting, Miami, FL, May 1992.

Address for correspondence and/or reprints: Janet T. Crimlisk, RN, MS, Boston Medical Center, One Boston Medical Center Place. Harrison Avenue Campus, Boston, MA 02118 (Tel: 617-534-5235)

© Williams & Wilkins 1997. All Rights Reserved.