zRisk Factors for Reintubation in Ventilator-Dependent Patients

Objective: Extubation failure in extubated patients may result in mortality. The objective of this study is to examine the risk factors for reintubation among long-term ventilator-dependent patients in Taiwan. Methods: This was a retrospective observational study. A total of 375 cases, including 287 successful weaning and 88 reintubation patients, aged older than 17 years and requiring more than 21 days of mechanical ventilation support, were identified from one district teaching hospital in southern Taiwan during 2007-2012. Their age, sex, comorbidities, clinical features, acute physiology and chronic health evaluation (APACHE) II score, Charlson Comorbidity Index (CCI) score, and biochemistry laboratory data were collected for analyses. Results: The reintubation group had more days of ventilator use and longer stays in the intensive care unit or respiratory care center. The multivariate logistic regression analysis found that higher APACH II score, lower hemoglobin concentration, higher CCI score and sepsis were associated with reintubation. The multivariate analysis revealed a 17% reduction in reintubation risk (adjusted odds ratio = 0.83; 95% confidence interval 0.68-0.91) for each one g/dL increase in hemoglobin concentration, but 2.5 times increase in reintubation risk (adjusted odds ratio = 2.54; 95% confidence interval 1.33-4.88) for patients with sepsis. Conclusions: The APACH II score, hemoglobin concentration, CCI score and sepsis are four factors significantly associated with reintubation. Preventing sepsis and maintaining hemoglobin concentration at a higher level may reduce the risk of reintubation, which can help clinicians be better prepared for planned extubation.