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An Evaluation of Risk Factors for Extubation Failure in Surgical Patients in Intensive Care

Deivert, Mary M. DNP, RN, ACNP; Quatrara, Beth DNP, RN, CNS; Kane, Catherine PhD, RN; Sohn, Min-Woong PhD; Childress, Melinda Bowles MSN, RN, ACNP; Turrentine, Florence E. PhD, RN

doi: 10.1097/DCC.0000000000000380
Research DIMENSION
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Background Reintubations following extubation from mechanical ventilation are costly, resulting in increased morbidity and mortality. The preparation for and timing of extubation from mechanical ventilation can reduce unplanned reintubations. Few studies have investigated reintubation in the surgical intensive care unit (SICU) population.

Objective To identify risk factors that predict extubation failure in nontrauma surgical postoperative intensive care patients.

Methods Retrospective analysis utilizing American College of Surgeons National Surgical Quality Improvement Program data and institutional clinical variables from July 1, 2013, to December 31, 2015, in a sample (N = 93) of surgical patients admitted postoperatively to a SICU with an endotracheal tube in place, requiring invasive mechanical ventilation. Logistic regression analysis was used to model extubation failure as a function of clinical variables in the 24 hours preceding extubation.

Results Of 93 patients, 70 were successfully extubated, and 23 experienced failure. Increasing respiratory rate in the 24 hours preceding extubation significantly predicted failure (odds ratio, 1.086; 95% confidence interval, 1.006-1.172; P = .034).

Discussion Elevated respiratory rates during the 24 hours preceding extubation are an underappreciated risk factor for extubation failure. This has direct implications for nurses who are assessing intensive care unit patients' readiness for extubation. Opportunity exists for nurses to better integrate respiratory rate data into extubation planning to improve unplanned reintubation rates in SICU patients.

Mary M. Deivert, DNP, RN, ACNP, is clinical instructor, University of Virginia School of Nursing, Charlottesville.

Beth Quatrara, DNP, RN, CNS, is clinical assistant professor, University of Virginia School of Nursing, Charlottesville.

Catherine Kane, PhD, RN, is professor, University of Virginia School of Nursing, Charlottesville.

Min-Woong Sohn, PhD, is associate professor, Public Health Sciences at the University of Virginia School of Medicine, Charlottesville.

Melinda Bowles Childress, MSN, RN, ACNP, is nurse practitioner, Surgical Intensive Care Unit, University of Virginia Health System, Charlottesville.

Florence E. Turrentine, PhD, RN, is associate professor, Department of Surgery, University of Virginia, Charlottesville.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Mary M. Deivert, DNP, RN, ACNP, University of Virginia School of Nursing, 202 Jeanette Lancaster Way, Charlottesville, VA 22903 (mmd3s@virginia.edu).

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