Indian Journal of Respiratory Care

IJRC Email      Register      Login

VOLUME 1 , ISSUE 1 ( January-June, 2012 ) > List of Articles

Original Article

Extubation failure in the ICU: Incidence, management and outcome

Dorothy Susannah Ranjitha

Keywords : Extubation failure, management, outcome

Citation Information : Ranjitha DS. Extubation failure in the ICU: Incidence, management and outcome. Indian J Respir Care 2012; 1 (1):53-58.

DOI: 10.5005/ijrc-1-1-53

License: NA

Published Online: 01-12-2022

Copyright Statement:  NA


Introduction: Extubation failure is said to be associated with increased morbidity and mortality. Patients and methods: This was a prospective, observational study of extubation failure among all patients who have been intubated and required ventilatory support in the Multi-Disciplinary Intensive Care Unit (MICU) of Kasturba Hospital, Manipal from 1st September 2007 to 30th September 2008. Criteria for considering extubation failure were similar to those used to evaluate need for intubation. Results: Of 167 patients who received invasive ventilation through an oral endotracheal tube, 145 were extubated successfully and 22 patients failed extubation. They were managed either with noninvasive ventilation (NIV) or reintubation as decided by the physician. The incidence of extubation failure was 13.1%. Only one patient could be managed with NIV. One was discharged against medical advice. Of the twenty patients who were reintubated, seven patients could be reextubated, seven required tracheostomy and six died. A mortality rate of 33% was observed in these patients. Extubation failure was mainly due to respiratory causes (15/21 patients), most of whom (11/15 patients) survived. Those due to nonrespiratory causes (6/15 patients) had 50% survival. The mean duration of mechanical ventilation prior to extubation was significantly lower among survivors (56 ± 25.1 hours) but the total duration of mechanical ventilation and ICU stay were not very different. Conclusions: Extubation failure is associated with high mortality. Extubation failure occurs most often due to respiratory causes and noninvasive positive pressure ventilation is not useful for patients who fail extubation.

  1. Rothaar RC and Epstein SK. Extubation failure. Magnitude of the problem, impact on outcomes, and prevention. Curr Opin Crit Care 2003; 9:59–66.
  2. Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med 1999; 27:340–7.
  3. Torres A, Gatell JM, Aznar E, et al. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995; 152:137–41.
  4. Epstein SK. Effect of unplanned extubation on outcome of mechanically ventilated medical intensive care unit patients: a case control study. Am J Respir Crit Care Med 1999; 159:A372.
  5. Rashkin M, Davis T. Acute complications of endotracheal intubation: relationship to reintubation, route, urgency and duration. Chest 1986; 89:165–7.
  6. Dupont H, Le Port Y, Paugam-Burtz C, et al. Reintubation after planned extubation in surgical ICU patients: a case-control study. Intensive Care Med 2001; 27:1875–80.
  7. Heyland DK, Cook DJ, Griffith L, et al. The attributable morbidity and mortality of ventilatorassociated pneumonia in the critically ill patient. Am J Respir Crit Care Med 1999, 159:1249–56.
  8. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997; 112:186–92.
  9. Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 2000; 161:1530–6.
  10. Colice G, Stukel T, Dain B. Laryngeal complications of prolonged intubation. Chest 1989; 96:877–84.
  11. Whited R. A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope 1984; 94:367–77.
  12. Burgess GE, Cooper JR, Marino RJ, et al. Laryngeal competence after tracheal extubation. Anesthesiology 1979; 51:73–7.
  13. De Larminat V, Montravers P, Dureuil B, et al. Alteration in swallowing reflex after extubation in intensive care unit patients. Crit Care Med 1995; 23:486–90.
  14. Leder SB, Cohn SM, Moller BA. Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients. Dysphagia 1998; 13:208–12.
  15. Hurford WE, Lynch KE, Strauss HW, et al. Myocardial perfusion as assessed by thallium 201 scintigraphy during the discontinuation of mechanical ventilation in ventilator-dependent patients. Anesthesiology 1991; 74:1007–16.
  16. Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998; 158:489–93.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.