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SOURCE: Tischenkel BR, et al. Daytime versus nighttime extubations: A comparison of reintubation, length of stay, and mortality. J Intensive Care Med 2014; Apr 24. [Epub ahead of print.]
This is a retrospective study of extubation outcomes in the five ICUs of Montefiore Medical Center in New York during a recent 23-month period. Institution-wide, respiratory therapist-driven weaning and extubation protocols (incorporating physician input for marginal data or clinician concern) and 24/7 intensivist ICU presence were in place at the time of the study. Once patients were clinically improved, with spontaneous respiratory rate and required inspired oxygen fraction and positive end-expiratory pressure requirements in an acceptable range, and were hemodynamically stable with manageable respiratory secretions and acceptable arterial blood gas results, they underwent a 30-minute spontaneous breathing trial with added pressure support to keep their tidal volumes at least 5 mL/kg ideal body weight. If the results of this trial were satisfactory according to standardized objective and subjective criteria, the patients were extubated. Outcomes with respect to the need for reintubation, hospital length of stay, and mortality were compared for patients extubated between 7 p.m. and 7 a.m. (coinciding with shift changes for nurses, respiratory therapists, and intensivists) vs those extubated during the day.
More than twice as many patients (n = 1555) had been extubated during daytime hours as during the night (n = 685). Reintubation occurred twice as frequently among patients extubated during the...