Factors Associated With Re-Intubation Within 14 Days After Ventilator Liberation

• Published in: Respiratory care Vol. 62; no. 12; p. 1557
• Main Authors: Chu, Chia-Chen, Liu, Chin-Jung, Yen, Suh-May, Chou, Wen-Yu, Kung, Pei-Tseng, Tsai, Yuh-Show, Tsai, Wen-Chen
• Format: Journal Article
• Language: English
• Published: United States 01.12.2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Databases, Factual; Female; Humans; Intubation, Intratracheal - statistics & numerical data; Logistic Models; Male; Middle Aged; Patient Readmission - statistics & numerical data; Quality of Health Care; Respiration, Artificial - methods; Respiration, Artificial - statistics & numerical data; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Retrospective Studies; Risk Factors; Taiwan; Treatment Failure; Ventilator Weaning - adverse effects; Young Adult; re-intubation; integrated delivery system; ventilator-dependent subject
• ISSN: 1943-3654
• DOI: 10.4187/respcare.05649

According to Taiwan's integrated delivery system policy, ventilator-dependent patients are successfully liberated from mechanical ventilation in accordance with step-down care. However, premature discharge affects the 14-d readmission quality index. Therefore, we explored the risk and related factors of subjects liberated from mechanical ventilation who were re-intubated within 14 d. This retrospective study analyzed a cohort of ventilator-dependent subjects 17 y of age and older using a population-based database from the Taiwan National Health Research Institutes Database from 2006 to 2010. Chi-square test and logistic regression analyses were used to explore whether subjects liberated from mechanical ventilation were re-intubated within 14 d and to investigate the related factors. A total of 15,840 ventilator-dependent subjects were liberated from mechanical ventilation, and 449 subjects were re-intubated within 14 d; the total re-intubation rate was 2.83%. The factors related to a higher risk of re-intubation were also the reasons for ventilator use, including complications, hospital accreditation level, and the ventilator weaning care stage. A higher risk of re-intubation was identified in subjects with COPD (odds ratio [OR] 1.32, 95% CI 1.02-1.7, = .035) or pneumonia (OR 1.4, 95% CI 1.07-1.86, = .02) and in subjects who stayed at a district hospital (OR 3.53, 95% CI 2.48-5.01, < .001). Liberation from mechanical ventilation in the respiratory care ward and home respiratory care were associated with the highest risk of re-intubation, which was 2.32 times that of ICU subjects ( < .001). Factors associated with re-intubation within 14 d after ventilator liberation are related to the level and quality of the care setting; thus, to prevent re-intubation, more attention should be paid to higher-risk ventilator-dependent subjects after they are liberated from mechanical ventilation.