Deleterious Effects of Reintubation of Mechanically Ventilated Patients

Abstract

About 15% of long-term mechanically ventilated patients who are removed from mechanical ventilation and extubated require reintubation within 48–72 hours after extubation. The reasons for reintubation can be divided in two groups: reintubation because of either upper airway obstruction or respiratory distress. Some authors have associated reintubation with a higher incidence of ventilator-associated pneumonia and a higher mortality. Studies that have analyzed mortality observed different outcomes depending upon relation with the reason for reintubation. Reintubation because of upper airway obstruction has a similar mortality of succesfully extubated patients, whereas reintubation because of respiratory distress has a mortality rate similar to nonextubated patients. These observations suggest that the principal factor associated with higher mortality associated to reintubation is the clinical condition that requires reintubation and not reintubation itself. At this moment, we only can predict the need for reintubation in unplanned extubations because there is no significant difference between scheduled extubation patients who require reintubation and those who do not require reintubation. Possible factors associated with risk of reintubation include left ventricular failure with resumption of spontaneous breathing, excessive sedation, or respiratory infection. The early management of respiratory distress postextubation may be an attractive time for noninvasive ventilation.