ATS: Reintubation more likely for nighttime extubations
(HealthDay)—Patients extubated at nighttime are more likely to be reintubated and have higher mortality than those extubated during the day, according to a study presented at the annual meeting of the American Thoracic Society, held from May 13 to 18 in San Francisco.
Hayley B. Gershengorn, M.D., from the Albert Einstein College of Medicine in New York City, and colleagues performed a retrospective cohort study of 32,760 mechanically ventilated (MV) adults aged 18 years and older admitted to 76 U.S. intensive care units (ICUs). The authors examined the frequency of and patient characteristics associated with nighttime extubations across ICUs.
The researchers found that 18.2 percent of patients were extubated overnight, with a median rate of nighttime extubations of 15.2 percent. After multivariable adjustment, patient factors associated with nighttime extubation included diagnosis of cardiovascular disease, sepsis, trauma, or neurologic (versus respiratory) disease; higher acute physiology score; absence of MV on ICU admission; and MV duration <12 hours. Patients who were extubated overnight were more often reintubated within 24 and 48 hours, but not at any time, based on propensity score-matched analysis. Mortality was higher and length of stay shorter in patients extubated overnight.
"Our results demonstrate more information is needed before we can say it is in our patients' best interest to make extubation a service we provide all of the time," Gershengorn said in a statement.
One author is an employee of Prescient Healthcare Consulting.
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