Archive for the ‘Reintubation’ Category

Reintubation as an Outcome Predictor in Trauma Patients (Discussion)

Reintubation as an Outcome Predictor in Trauma Patients (Discussion)Prediction of outcome has always been a goal of medicine. Recently, economic forces, ethical concerns, and resource allocation have spurred mathematically complex prognostic formulas. Efforts to simplify prognostic determination have focused on simple characteristics or events that can be detected easily. The need for additional ventilatory support or airway protection after initial discontinuation of such support has been proposed to be a simple identifier of mortality risk in critically ill patients.

Current data available on reintubation confirm that the differences in patient characteristics from the medical ICU, surgical ICU, and trauma ICU extend to ventilatory mechanics. A group of severely ill medical ICU patients (overall survival, 38%) had a significant relationship between reintubation and an increased rate of complications. Mortality in the reintubated group was not reported; pulmonary compromise was the most frequent cause for reintubation (32.5%), whereas airway obstruction accounted for only 12.5% of extubation failures, with stridor occurring in 5 of 6 patients, accounting for 18% of the study population, but only 4 of whom were reintubated. Read the rest of this entry »

Reintubation as an Outcome Predictor in Trauma Patients (Results)

Reintubation as an Outcome Predictor in Trauma Patients (Results)During the study period, 2,516 patients were admitted to the trauma center. Blunt mechanisms (motor vehicle crashes, falls, etc) were most frequent cause for hospital admission. There were 405 patients who were intubated or arrived intubated.

Twenty-four patients were reintubated 27 times for 19 planned, 5 self-extubations, and 3 unplanned extu-bations (Table 2). All patients were intubated orotracheally. There were 8 women and 16 men, with a mean age of 37 years (range, 14 to 80 years). Mean Injury Severity Score (ISS) was 20, and the mean Glasgow Coma Scale (GCS) at hospital admission was 11. Length of intubation ranged from 6 h to 9 days, with a mean of 3.6 days. No patient suffered direct laryngeal trauma, and there were no head and neck bums or smoke inhalation injuries.  Read the rest of this entry »

Reintubation as an Outcome Predictor in Trauma Patients (Materials and Methods)

Reintubation as an Outcome Predictor in Trauma Patients (Materials and Methods)We performed a retrospective case review of the experience at the Southern New Jersey Regional Trauma Center from October 1992 to March 1994. The Southern New Jersey Regional Trauma Center has a catchment area of nearly 2 million people. Data were obtained from review of the patients’ hospital records, the Trauma Registry, and minutes of the Quality Assurance Committee of the Division of Trauma, where reintubation is a mandatory review filter.

Patients admitted to the trauma ICU who required reintubation during the course of their hospitalization were studied. Patients were intubated in the field by experienced emergency medical technicians at the paramedic level or flight nurses. In the trauma admitting area or operating room, intubation was performed by experienced certified registered nurse anesthetists or anesthesiologists. Read the rest of this entry »

Reintubation as an Outcome Predictor in Trauma Patients (Introduction)

Reintubation as an Outcome Predictor in Trauma Patients (Introduction)Study objective: Determine reintubation rate, identify its cause, and detail adverse outcomes from reintubation.
Design: Retrospective review of extubation failures in the trauma ICU.
Setting: University hospital and regional trauma center.
Patients: Four hundred five patients arriving intubated or requiring intubation during hospitalization after 2,516 traumatic injury admissions over 18 months.
Interventions: None. Read the rest of this entry »

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