Time definition of reintubation most relevant to patient outcomes in critically ill patients: a multicenter cohort study

Tanaka, Aiko; Shimomura, Yoshimitsu; Uchiyama, Akinori; Tokuhira, Natsuko; Kitamura, Tetsuhisa; Iwata, Hirofumi; Hashimoto, Haruka; Ishigaki, Suguru; Enokidani, Yusuke; Yamashita, Tomonori; Koyama, Yukiko; Iguchi, Naoya; Yoshida, Takeshi; Fujino, Yuji

doi:https://doi.org/10.1186/s13054-023-04668-3

Time definition of reintubation most relevant to patient outcomes in critically ill patients: a multicenter cohort study

Tanaka, Aiko; Shimomura, Yoshimitsu; Uchiyama, Akinori et al.

Critical Care, 2023, 27(1), 378

Number of Access:4,100（2025-08-14 15:05 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/93238

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Title	Time definition of reintubation most relevant to patient outcomes in critically ill patients: a multicenter cohort study
Creator	CreatorName Tanaka, Aiko
	CreatorName Shimomura, Yoshimitsu
	NRID 1000000324856 1000000324856 CreatorName Uchiyama, Akinori
	NRID 1000060597227 1000060597227 researchmap permalink osaka-toku osaka-toku Scopus Author ID 54400442600 54400442600 CreatorName Tokuhira, Natsuko
	NRID 1000030639810 1000030639810 ORCID 0000-0003-0107-0580 0000-0003-0107-0580 researchmap permalink Kitamura_T Kitamura_T Scopus Author ID 22234282700 22234282700 CreatorName Kitamura, Tetsuhisa
	CreatorName Iwata, Hirofumi
	CreatorName Hashimoto, Haruka
	CreatorName Ishigaki, Suguru
	CreatorName Enokidani, Yusuke
	researchmap permalink tomonori58 tomonori58 CreatorName Yamashita, Tomonori
	NRID 1000070942423 1000070942423 researchmap permalink intensive intensive Scopus Author ID 57195684605 57195684605 CreatorName Koyama, Yukiko
	NRID 1000000372623 1000000372623 researchmap permalink n_iguchi n_iguchi Scopus Author ID 35825389300 35825389300 CreatorName Iguchi, Naoya
	NRID 1000050725520 1000050725520 researchmap permalink t_yoshida t_yoshida Scopus Author ID 55531137700 55531137700 CreatorName Yoshida, Takeshi
	NRID 1000050252672 1000050252672 researchmap permalink y_fujino y_fujino Scopus Author ID 19134445600 19134445600 CreatorName Fujino, Yuji
Subject	Reintubation
	Extubation failure
	Mechanical ventilation
	Mortality
	Intensive care
	Diffraction wave
Description	Tanaka A., Shimomura Y., Uchiyama A., et al. Time definition of reintubation most relevant to patient outcomes in critically ill patients: a multicenter cohort study. Critical Care 27, 378 (2023); https://doi.org/10.1186/s13054-023-04668-3.
Abstract	Background: Reintubation is a common complication in critically ill patients requiring mechanical ventilation. Although reintubation has been demonstrated to be associated with patient outcomes, its time definition varies widely among guidelines and in the literature. This study aimed to determine the association between reintubation and patient outcomes as well as the consequences of the time elapsed between extubation and reintubation on patient outcomes. Methods: This was a multicenter retrospective cohort study of critically ill patients conducted between April 2015 and March 2021. Adult patients who underwent mechanical ventilation and extubation in intensive care units (ICUs) were investigated utilizing the Japanese Intensive Care PAtient Database. The primary and secondary outcomes were in-hospital and ICU mortality. The association between reintubation and clinical outcomes was studied using Cox proportional hazards analysis. Among the patients who underwent reintubation, a Cox proportional hazard analysis was conducted to evaluate patient outcomes according to the number of days from extubation to reintubation. Results: Overall, 184,705 patients in 75 ICUs were screened, and 1849 patients underwent reintubation among 48,082 extubated patients. After adjustment for potential confounders, multivariable analysis revealed a significant association between reintubation and increased in-hospital and ICU mortality (adjusted hazard ratio [HR] 1.520, 95% confidence interval [CI] 1.359–1.700, and adjusted HR 1.325, 95% CI 1.076–1.633, respectively). Among the reintubated patients, 1037 (56.1%) were reintubated within 24 h after extubation, 418 (22.6%) at 24–48 h, 198 (10.7%) at 48–72 h, 111 (6.0%) at 72–96 h, and 85 (4.6%) at 96–120 h. Multivariable Cox proportional hazard analysis showed that in-hospital and ICU mortality was highest in patients reintubated at 72–96 h (adjusted HR 1.528, 95% CI 1.062–2.197, and adjusted HR 1.334, 95% CI 0.756–2.352, respectively; referenced to reintubation within 24 h). Conclusions: Reintubation was associated with a significant increase in in-hospital and ICU mortality. The highest mortality rates were observed in patients who were reintubated between 72 and 96 h after extubation. Further studies are warranted for the optimal observation of extubated patients in clinical practice and to strengthen the evidence for mechanical ventilation.
Publisher	BioMed Central Ltd
Source Title	Critical Care
Volume (Issue)	27(1)
Page	378
Date of Issued	2023-09-30
Language	English
Handle URL	https://hdl.handle.net/11094/93238
PISSN	13648535
eISSN	1466609X
Relation.isIdenticalTo	DOI (Publisher Version) https://doi.org/10.1186/s13054-023-04668-3
Access Rights	open access
CopyRight	This article is licensed under a Creative Commons Attribution 4.0 International License.
oaire:version	Version of Record
Category	学術雑誌論文 Journal Article

Resource Type	journal article
Local Type	Journal Article
DCMI Type	Text
DCTERMS.bibliographicCitation	Critical Care. 2023, 27(1), p. 378
DC.title	Time definition of reintubation most relevant to patient outcomes in critically ill patients: a multicenter cohort study
DC.creator	Tanaka, Aiko
	Shimomura, Yoshimitsu
	Uchiyama, Akinori
	Tokuhira, Natsuko
	Kitamura, Tetsuhisa
	Iwata, Hirofumi
	Hashimoto, Haruka
	Ishigaki, Suguru
	Enokidani, Yusuke
	Yamashita, Tomonori
	Koyama, Yukiko
	Iguchi, Naoya
	Yoshida, Takeshi
	Fujino, Yuji
DC.publisher	BioMed Central Ltd
DC.language' scheme='DCTERMS.RFC1766	English
DC.type' scheme='DCTERMS.DCMIType	Text
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2023-09-30
DC.identifier	https://doi.org/10.1186/s13054-023-04668-3
DC.subject	Reintubation
	Extubation failure
	Mechanical ventilation
	Mortality
	Intensive care
	Diffraction wave
DC.description	Tanaka A., Shimomura Y., Uchiyama A., et al. Time definition of reintubation most relevant to patient outcomes in critically ill patients: a multicenter cohort study. Critical Care 27, 378 (2023); https://doi.org/10.1186/s13054-023-04668-3.
DCTERMS.abstract	Background: Reintubation is a common complication in critically ill patients requiring mechanical ventilation. Although reintubation has been demonstrated to be associated with patient outcomes, its time definition varies widely among guidelines and in the literature. This study aimed to determine the association between reintubation and patient outcomes as well as the consequences of the time elapsed between extubation and reintubation on patient outcomes. Methods: This was a multicenter retrospective cohort study of critically ill patients conducted between April 2015 and March 2021. Adult patients who underwent mechanical ventilation and extubation in intensive care units (ICUs) were investigated utilizing the Japanese Intensive Care PAtient Database. The primary and secondary outcomes were in-hospital and ICU mortality. The association between reintubation and clinical outcomes was studied using Cox proportional hazards analysis. Among the patients who underwent reintubation, a Cox proportional hazard analysis was conducted to evaluate patient outcomes according to the number of days from extubation to reintubation. Results: Overall, 184,705 patients in 75 ICUs were screened, and 1849 patients underwent reintubation among 48,082 extubated patients. After adjustment for potential confounders, multivariable analysis revealed a significant association between reintubation and increased in-hospital and ICU mortality (adjusted hazard ratio [HR] 1.520, 95% confidence interval [CI] 1.359–1.700, and adjusted HR 1.325, 95% CI 1.076–1.633, respectively). Among the reintubated patients, 1037 (56.1%) were reintubated within 24 h after extubation, 418 (22.6%) at 24–48 h, 198 (10.7%) at 48–72 h, 111 (6.0%) at 72–96 h, and 85 (4.6%) at 96–120 h. Multivariable Cox proportional hazard analysis showed that in-hospital and ICU mortality was highest in patients reintubated at 72–96 h (adjusted HR 1.528, 95% CI 1.062–2.197, and adjusted HR 1.334, 95% CI 0.756–2.352, respectively; referenced to reintubation within 24 h). Conclusions: Reintubation was associated with a significant increase in in-hospital and ICU mortality. The highest mortality rates were observed in patients who were reintubated between 72 and 96 h after extubation. Further studies are warranted for the optimal observation of extubated patients in clinical practice and to strengthen the evidence for mechanical ventilation.
DC.rights	This article is licensed under a Creative Commons Attribution 4.0 International License.
DC.format	93238
citation_title	Time definition of reintubation most relevant to patient outcomes in critically ill patients: a multicenter cohort study
citation_author	Tanaka, Aiko
	Shimomura, Yoshimitsu
	Uchiyama, Akinori
	Tokuhira, Natsuko
	Kitamura, Tetsuhisa
	Iwata, Hirofumi
	Hashimoto, Haruka
	Ishigaki, Suguru
	Enokidani, Yusuke
	Yamashita, Tomonori
	Koyama, Yukiko
	Iguchi, Naoya
	Yoshida, Takeshi
	Fujino, Yuji
citation_publisher	BioMed Central Ltd
citation_language	English
citation_date	2023-09-30
citation_journal_title	Critical Care
citation_volume	27
citation_issue	1
citation_firstpage	378
citation_doi	https://doi.org/10.1186/s13054-023-04668-3
citation_public_url	https://hdl.handle.net/11094/93238

Time definition of reintubation most relevant to patient outcomes in critically ill patients: a multicenter cohort study

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