This article appeared in the December 6, 2012 issue of the New England Journal of Medicine:
As anesthesiologists we “wean patients from ventilators” daily. At first I thought, “ho hum,” what am I going to learn from this?
However! It seems as though I am called to re-intubate one or more patients in the ICUs every night that I am on call.
According to the article:
Approximately 15% of patients in whom mechanical ventilation is discontinued require re-intubation within 48 hours. Rates of extubation failure vary considerably among ICUs. For example, the average rate of failed extubation in surgical ICUs ranges from 5 to 8%, whereas it is often as high as 17% in medical or neurologic ICUs. Patients who require re-intubation have an increased risk of death, a prolonged hospital stay, and a decreased likelihood of returning home, as compared with patients in whom discontinuation of mechanical ventilation is successful. Thus, it is essential that critical care physicians identify risk factors for failure of extubation despite successful spontaneous breathing trials.
Maybe my nighttime experience is par for the course. Then again maybe we could be doing better.