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 Scopus citations

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 (US)
Pages (from-to)376-383
Number of pages8
JournalSurgery (United States)
Volume154
Issue number2
DOIs
StatePublished - Aug 1 2013

ASJC Scopus subject areas

  • Surgery

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    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 (United States), 154(2), 376-383. https://doi.org/10.1016/j.surg.2013.05.006