Brown et al identified risk factors for reintubation in trauma patients. These can help to identify a patient who may require more aggressive management or deferred extubation. The authors are from University Medical Center Breckenridge in Austin, Texas.
Patient selection: trauma patient who has been extubated
Risk factors for reintubation:
(1) spinal and/or extremity fracture(s)
(2) lower Glasgow Coma Score (GCS) at the time of extubation
(3) initial intubation performed to preserve the airway
(4) delirium tremens
where:
• Patients who were reintubated had a GCS of 9 +/- 1 while those who were not reintubated had a GCS of 10 +/- 1. A GCS less than 10 will be used in the implementation.
If a patient needs to be reintubated, most events occur within 24 hours (mean time 15 hours).
A patient who needs to be reintubated is more likely to have a longer hospital stay, more complications and need for prolonged ventilatory support.
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