Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study

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Abstract

Background

This study aimed to identify the risk factors and evaluate the prognosis of unplanned reintubation caused by acute airway compromise (AAC) after general anesthesia.

Methods

This case-control study included surgical patients who underwent unplanned reintubation in the operating room and postanesthesia care unit after general anesthesia between January 1, 2014, and December 31, 2018. Cases due to AAC were matched 1:4 with randomly selected controls.

Results

A total of 123,068 patients were included, and reintubation due to AAC was performed in 36 patients (approximate incidence 0.03%). Univariable analysis revealed that male sex, age > 65, ASA physical status 3, sepsis, heart disease history, cerebral infarction history, Cormack Lehane grade, surgery type, fresh frozen plasma infusion, increased intubation duration, white blood cell count, and creatinine clearance rate were related to AAC-caused unplanned reintubation. Multivariable analysis revealed that age > 65 (OR = 7.50, 95% CI 2.47–22.81, P < 0.001), ASA physical status 3 (OR = 6.51, 95% CI 1.18–35.92, P = 0.032), head-neck surgery (OR = 4.94, 95% CI 1.33–18.36, P = 0.017) or thoracic surgery (OR = 12.56, 95% CI 2.93–53.90, P < 0.001) and a high fluid load (OR = 3.04, 95% CI 1.16–7.99, P = 0.024) were associated with AAC-caused unplanned reintubation. AAC-caused unplanned reintubation patients had longer postoperative hospital (OR = 5.26, 95% CI 1.57–8.95, P < 0.001) and intensive care unit days (OR = 3.94, 95% CI 1.69–6.18, P < 0.001).

Conclusions

Age > 65, ASA physical status 3, head-neck or thoracic surgery and high fluid load were found to be associated with AAC-caused unplanned reintubation.

Related collections

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Extubation failure is associated with a poor prognosis, but the respective roles for reintubation per se and underlying disease severity remain unclear. Our objectives were to evaluate the impact of failed extubation, whether planned or unplanned, on patient outcomes and to identify a patient subset at risk for extubation failure. Prospective 1-yr observational study with daily data collection. : Thirteen-bed medical intensive care unit in a teaching hospital. Consecutive patients requiring invasive mechanical ventilation were screened and followed until discharge or death. None. Of 168 planned extubations in 340 patients, 26 (15%) failed. Of these 26 patients, seven (27%) had pneumonia and 13 (50%) died after reintubation. Compared with successfully extubated patients, the patients with failed extubation were not significantly different regarding disease severity, mechanical ventilation duration, or blood gas values. Age and underlying diseases were the only factors associated with extubation failure, and extubation failure occurred in 34% of patients >65 yrs with chronic cardiac or respiratory disease compared with only 9% of other patients (p 65 yrs with underlying chronic cardiac or respiratory disease are at high risk for extubation failure and subsequent pneumonia and death. Contrasting with successful extubation, failed planned or unplanned extubation was followed by marked clinical deterioration, suggesting a direct and specific effect of extubation failure and reintubation on patient outcomes.

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Author and article information

Contributors

Le Shen:

ORCID: http://orcid.org/0000-0002-2563-0012

pumchshenle@aliyun.com

Journal

Journal ID (nlm-ta): BMC Anesthesiol

Journal ID (iso-abbrev): BMC Anesthesiol

Title: BMC Anesthesiology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2253

Publication date (Electronic): 12 January 2021

Publication date PMC-release: 12 January 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 17

Affiliations

[1 ]Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730 China

[2 ]Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730 China

Author information

Le Shen http://orcid.org/0000-0002-2563-0012

Article

Publisher ID: 1238

DOI: 10.1186/s12871-021-01238-4

PMC ID: 7802267

PubMed ID: 33435881

SO-VID: 2f21046b-b0be-4904-a204-69dd1d12e5ed

License:

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