Unplanned intubation

When and why does this deadly complication occur?

Daniel P. Milgrom, Victor C. Njoku, Alison M. Fecher, E. Molly Kilbane, Henry A. Pitt

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Risk factors for unplanned intubation have been delineated, but details regarding when and why reintubations occur as well as strategies for prevention have not been defined. Methods Over a 2-year period, 104 of 3,141 patients (3.3%) monitored via the American College of Surgeons-National Surgical Quality Improvement Program required unplanned intubation. These patients were compared to those who remained extubated and were characterized by (1) the operation performed; (2) the postoperative day when reintubation occurred; and (3) the underlying causes. Results Patients who required reintubation were significantly older (65.8 years) and were more likely to be male (55%) and to have several comorbidities, weight loss (16%), dependency (14%), or sepsis (9%). The operations complicated most commonly by unplanned intubation were gastrectomy (13%), nephrectomy (10%), colectomy (9%), pancreatectomy (8%), hepatectomy (7%), and enterectomy (6%). The most common causes and median postoperative days were sepsis (33%, day 8) and aspiration/pneumonia (31%, day 4). Sepsis was due most commonly to an abdominal or pelvic abscess (74%), which was frequently not recognized despite an inflammatory response. Aspiration occurred most commonly after upper abdominal operations (78%) despite signs of diminished bowel function. Conclusion Postoperative sepsis and aspiration/pneumonia account for two thirds of unplanned intubations. Opportunities for management of patients exist for the prevention of this deadly complication.

Original languageEnglish
Pages (from-to)376-383
Number of pages8
JournalSurgery
Volume154
Issue number2
DOIs
StatePublished - Aug 2013

Fingerprint

Intubation
Sepsis
Aspiration Pneumonia
Pancreatectomy
Colectomy
Hepatectomy
Gastrectomy
Quality Improvement
Nephrectomy
Abscess
Comorbidity
Weight Loss

ASJC Scopus subject areas

  • Surgery

Cite this

Milgrom, D. P., Njoku, V. C., Fecher, A. M., Kilbane, E. M., & Pitt, H. A. (2013). Unplanned intubation: When and why does this deadly complication occur? Surgery, 154(2), 376-383. https://doi.org/10.1016/j.surg.2013.05.006

Unplanned intubation : When and why does this deadly complication occur? / Milgrom, Daniel P.; Njoku, Victor C.; Fecher, Alison M.; Kilbane, E. Molly; Pitt, Henry A.

In: Surgery, Vol. 154, No. 2, 08.2013, p. 376-383.

Research output: Contribution to journalArticle

Milgrom, DP, Njoku, VC, Fecher, AM, Kilbane, EM & Pitt, HA 2013, 'Unplanned intubation: When and why does this deadly complication occur?', Surgery, vol. 154, no. 2, pp. 376-383. https://doi.org/10.1016/j.surg.2013.05.006
Milgrom DP, Njoku VC, Fecher AM, Kilbane EM, Pitt HA. Unplanned intubation: When and why does this deadly complication occur? Surgery. 2013 Aug;154(2):376-383. https://doi.org/10.1016/j.surg.2013.05.006
Milgrom, Daniel P. ; Njoku, Victor C. ; Fecher, Alison M. ; Kilbane, E. Molly ; Pitt, Henry A. / Unplanned intubation : When and why does this deadly complication occur?. In: Surgery. 2013 ; Vol. 154, No. 2. pp. 376-383.
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abstract = "Background Risk factors for unplanned intubation have been delineated, but details regarding when and why reintubations occur as well as strategies for prevention have not been defined. Methods Over a 2-year period, 104 of 3,141 patients (3.3{\%}) monitored via the American College of Surgeons-National Surgical Quality Improvement Program required unplanned intubation. These patients were compared to those who remained extubated and were characterized by (1) the operation performed; (2) the postoperative day when reintubation occurred; and (3) the underlying causes. Results Patients who required reintubation were significantly older (65.8 years) and were more likely to be male (55{\%}) and to have several comorbidities, weight loss (16{\%}), dependency (14{\%}), or sepsis (9{\%}). The operations complicated most commonly by unplanned intubation were gastrectomy (13{\%}), nephrectomy (10{\%}), colectomy (9{\%}), pancreatectomy (8{\%}), hepatectomy (7{\%}), and enterectomy (6{\%}). The most common causes and median postoperative days were sepsis (33{\%}, day 8) and aspiration/pneumonia (31{\%}, day 4). Sepsis was due most commonly to an abdominal or pelvic abscess (74{\%}), which was frequently not recognized despite an inflammatory response. Aspiration occurred most commonly after upper abdominal operations (78{\%}) despite signs of diminished bowel function. Conclusion Postoperative sepsis and aspiration/pneumonia account for two thirds of unplanned intubations. Opportunities for management of patients exist for the prevention of this deadly complication.",
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