Reintubation in Patients with Acute Poisoning: Risk Factor Analysis

Document Type : Original Article (s)

Authors

1 Professor, Department of Clinical Toxicology, School of Medicine AND Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, Department of Clinical Toxicology, School of Medicine AND Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

4 Associate Professor, Department of Anesthesiology, School of Medicine AND Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

5 Professor, Department of Anesthesiology, School of Medicine AND Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Endotracheal intubation is one of the most common interventions in the intensive care unit to provide a reliable airway for patients. We investigated the causes of endotracheal reintubation in cases with poisoning admitted to the intensive care unit.Methods: In this case-control study, 43 patients required endotracheal reintubation (case group) and 45 patients in the control group with only one time endotracheal intubation were compared according to clinical, paraclinical, and post-treatment sign and symptoms.Findings: There was a significant difference between the two groups based on the cause of consumption of drug or poison (suicide, accidental, or unspecified) (P < 0.050). In the group with reintubation, opioid poisoning was more common. Most of the patients in the reintubation group (55.8%) were recovered with complications. However, most patients in the control group (64.4%) were recovered without complications (P < 0.050). The duration of hospitalization in case group was significantly higher than control group (P = 0.004). Patients with accidental poisoning had less chance of reintubation [Odds ratio (OR) = 0.32; 95% of confidence interval (95%CI) = 0.12-0.89; P= 0.020]. Whereas, spontaneous extubation increased the risk of reintubation (OR = 8.30; 95%CI = 1.73-39.67; P = 0.008). Moreover, the possibility of reintubation was higher in spontaneous extubation.Conclusion: Spontaneous extubation and the cause of poisoning are predictive factors for reintubation. In cases where the patient needs endotracheal reintubation, the duration of hospitalization and complications are higher.

Keywords

References

  1. Alanazi A. Intubations and airway management: An overview of Hassles through third millennium. J Emerg Trauma Shock 2015; 8(2): 99-107.
  2. Raehl CL. Endotracheal drug therapy in cardiopulmonary resuscitation. Clin Pharm 1986; 5(7): 572-9.
  3. Holzapfel L. Nasal vs oral intubation. Minerva Anestesiol 2003; 69(5): 348-52.
  4. Bobinskas AM, Kanatas AN, Law MB, Fabbroni, G. Simple method of securing an airway while accessing a bleeding tracheostomy site when nasal or oral endotracheal intubation is not feasible. Br J Oral Maxillofac Surg 2016; 54 (9): 1042-3.
  5. Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth 2018; 120(2): 323-52.
  6. Batra Y, Mathew P. Airway management with endotracheal intubation including awake intubation and blind intubation. Indian J Anaesth 2005; 49(4): 263.
  7. Johnson RF, Jr., Gustin J. Acute lung injury and acute respiratory distress syndrome requiring tracheal intubation and mechanical ventilation in the intensive care unit: impact on managing uncertainty for patient-centered communication. Am J Hosp Palliat Care 2013; 30(6): 569-75.
  8. Crulli B, Loron G, Nishisaki A, Harrington K, Essouri S, Emeriaud G. Safety of paediatric tracheal intubation after non-invasive ventilation failure. Pediatr Pulmonol 2015; 51(2): 165-72.
  9. Lee JH, Turner DA, Kamat P, Nett S, Shults J, Nadkarni VM, et al. The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study. BMC Pediatr 2016; 16: 58.
  10. Christian S, Manji M. Indications for endotracheal intubation and ventilation. Trauma 2004; 6(4): 249-54.
  11. Hua A, Haight S, Hoffman RS, Manini AF. Endotracheal intubation after acute drug overdoses: incidence, complications, and risk factors. J Emerg Med 2017; 52(1): 59-65.
  12. Rujirojindakul P, Geater AF, McNeil EB, Vasinanukorn P, Prathep S, Asim W, et al. Risk factors for reintubation in the post-anaesthetic care unit: A case-control study. Br J Anaesth 2012; 109(4): 636-42.
  13. Kulkarni AP, Agarwal V. Extubation failure in intensive care unit: Predictors and management. Indian J Crit Care Med 2008; 12(1): 1-9.
  14. Elmer J, Lee S, Rittenberger JC, Dargin J, Winger D, Emlet L. Reintubation in critically ill patients: procedural complications and implications for care. Crit Care 2015; 19: 12.
  15. Whitmore D, Mahambray T. Reintubation following planned extubation: incidence, mortality and risk factorsD Whitmorecorresponding author and T Mahambray. Intensive Care Med Exp 2015; 3(Suppl 1): A684.
  16. Beckmann U, Gillies DM. Factors associated with reintubation in intensive care: An analysis of causes and outcomes. Chest 2001; 120(2): 538-42.
  17. Ting PC, Chou AH, Yang MW, Ho AC, Chang CJ, Chang SC. Postoperative reintubation after planned extubation: A review of 137,866 general anesthetics from 2005 to 2007 in a Medical Center of Taiwan. Acta Anaesthesiol Taiwan 2010; 48(4): 167-71.
  18. Donaldson AE, Larsen GY, Fullerton-Gleason L, Olson LM. Classifying undetermined poisoning deaths. Inj Prev 2006; 12(5): 338-43.
  19. Kleiman EM, Law KC, Anestis MD. Do theories of suicide play well together? Integrating components of the hopelessness and interpersonal psychological theories of suicide. Compr Psychiatry 2014; 55(3): 431-8.
  20. Bjorkenstam C, Johansson LA, Nordstrom P, Thiblin I, Fugelstad A, Hallqvist J, et al. Suicide or undetermined intent? A register-based study of signs of misclassification. Popul Health Metr 2014; 12: 11.
  21. Karch DL, Dahlberg LL, Patel N, Davis TW, Logan JE, Hill HA, et al. Surveillance for violent deaths--national violent death reporting system, 16 States, 2006. MMWR Surveill Summ 2009; 58(1): 1-44.
  22. Brown CV, Daigle JB, Foulkrod KH, Brouillette B, Clark A, Czysz C, et al. Risk factors associated with early reintubation in trauma patients: a prospective observational study. J Trauma 2011; 71(1): 37-41.
  23. Baisch SD, Wheeler WB, Kurachek SC, Cornfield DN. Extubation failure in pediatric intensive care incidence and outcomes. Pediatr Crit Care Med 2005; 6(3): 312-8.
  24. Frutos-Vivar F, Esteban A, Apezteguia C, Gonzalez M, Arabi Y, Restrepo MI, et al. Outcome of reintubated patients after scheduled extubation. J Crit Care 2011; 26(5): 502-9.
  25. Lin HT, Ting PC, Chang WY, Yang MW, Chang CJ, Chou AH. Predictive risk index and prognosis of postoperative reintubation after planned extubation during general anesthesia: a single-center retrospective case-controlled study in Taiwan from 2005 to 2009. Acta Anaesthesiol Taiwan 2013; 51(1): 3-9.
  26. Mahmood S, Alani M, Al-Thani H, Mahmood I, El-Menyar A, Latifi R. Predictors of reintubation in trauma intensive care unit: qatar experience. Oman Med J 2014; 29(4): 289-93.
  27. Epstein SK. Extubation failure: An outcome to be avoided. Crit Care 2004; 8(5): 310-2.
  28. Jabal-Ameli M, Eizadi-Mood N, Tavangar-Rad P, Yaraghi A. The relationship between the scores of bispectral index (BIS) and glasgow coma scale (GCS) in poisoned patients with decreased level of consciousness requiring tracheal intubation. J Isfahan Med Sch 2016; 33(364): 2256-62. [In Persian].
  29. Eizadi-Mood N, Yaraghi A, Alikhasi M, Jabalameli M, Farsaei S, Sabzghabaee AM. Prediction of endotracheal intubation outcome in opioid-poisoned patients: A clinical approach to bispectral monitoring. Can J Respir Ther 2014; 50(3): 83-6.
  30. Eizadi-Mood N, Shariati M, Yaraghi A, Gheshlaghi F, Masoomi G, Dana Siadat Z. Predictive factors of endotracheal intubation in poisoned patients with organophosphates. J Isfahan Med Sch 2011; 29(150): 1058-69. [In Persian].
  31. Mirmoghtadaee P, Eizadi-Mood N, Sabzghabaee AM, Yaraghi A, Hosseinzadeh F, Dorvashi G, Mirhosseini SMM. Risk factors for endotracheal intubation and mechanical ventilation in patients with opioids intoxication. Pak J Med Sci 2012; 28(2): 279-28.
  32. Eizadi-Mood N, Halakoei L, Yaraghi A, Jabalameli M, Talakoub R, Sabzghabaee AM. Bispectral index in poisoning cases with multi-drug ingestion: A predictable role for early endotracheal intubation. J Res Pharm Pract 2018; 7(1): 36-40.
  33. Rashkin MC, Davis T. Acute complications of endotracheal intubation. Relationship to reintubation, route, urgency, and duration. Chest 1986; 89(2): 165-7.
  34. Hayashi LY, Gazzotti MR, Vidotto MC, Jardim JR. Incidence, indication and complications of postoperative reintubation after elective intracranial surgery. Sao Paulo Med J 2013; 131(3): 158-65.
  35. de LA, Alberti C, Azoulay E, Le ME, Cheval C, Vincent F, et al. Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: a prospective multicenter study. Anesthesiology 2002; 97(1): 148-56.
  36. Shoji CY, Figuereido LC, Calixtre EM, Rodrigues CDA, Falcao ALE, Martins PP, et al. Reintubation of patients submitted to cardiac surgery: A retrospective analysis. Rev Bras Ter Intensiva 2017; 29(2): 180-7.
Journal of Isfahan Medical School
Volume 36, Issue 486 - Serial Number 486
May and June 2018
Pages 743-749

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History

  • Receive Date: 21 May 2018
  • Revise Date:
  • Accept Date: 06 April 2022

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