Incidence, Risk Factors, and Clinical Outcomes of Reintubation Following Planned Extubation in a Postanesthetic Care Unit: A Case-control Study

Srisuluk  Kacha; Busabawan  Sawangsub; Nutchanart  Bunchungmongkol; Tanyong  Pipanmekaporn

Authors

Srisuluk Kacha Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0009-0009-9515-3483
Busabawan Sawangsub Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand
Nutchanart Bunchungmongkol Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0000-0002-6849-8701
Tanyong Pipanmekaporn Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0000-0001-7154-5671

Keywords:

reintubation, PACU, postoperative outcome, anesthesia

Abstract

Objective This study aimed to determine the incidence, risk factors, and clinical outcomes associated with reintubation after a planned extubation (RAP) during the postoperative period.

Methods A retrospective case-control study was conducted on patients with RAP in an operating theater or postanesthetic care unit. Forty-six cases between 2013 and 2017 were extracted from the anesthetic database of the Department of Anesthesiology, Faculty of Medicine, Chiang Mai University. Cases with RAP were randomly matched in a ratio of 1:4 with selected controls. Univariable and multivariable logistic regression were used for the analysis and results are presented as the odds ratio (OR) and 95% confidence interval (CI).

Results A total of 230 patients (46 cases and 184 controls) were included. The independent risk factors of RAP included creatinine clearance (CrCl) 25-60 mL/min (OR = 3.34; 95% CI: 1.83-9.46), CrCl < 25 mL/min (OR = 4.26; 95% CI: 1.04-17.47), preoperative oxygen saturation ≤ 94% (OR = 16.78; 95% CI 3.99-70.57), and use of aminosteroid muscle relaxants (OR = 3.00; 95% CI: 1.23-7.31). The immediate outcomes of RAP were unplanned ICU admission (65.22%), major respiratory events (19.57%), and cardiovascular events (19.57%).

Conclusions Independent risk factors of RAP were renal insufficiency, CrCl < 60 mL/min, preoperative oxygen saturation ≤ 94%, creatinine clearance 25-60 mL/min, and use of an aminosteroid muscle relaxant. Proper evaluation and management before extubation could help prevent the occurrence of RAP.

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