Michael Traynor, MD, MPh
Dr.
Mayo Clinic Rochester, United States
Disclosure information not submitted.
Stephanie Heller, M.D.
Associate Professor of Surgery
Mayo Clinic Rochester, United States
Disclosure information not submitted.
Beth Ballinger, MD
Assistant Professor of Surgery
Mayo Clinic, United States
Disclosure information not submitted.
Erica Loomis, MD
Assistant Professor of Surgery
Mayo Clinic, United States
Disclosure information not submitted.
Title: Outcome of Re-Intubated Patients in the Trauma Intensive Care Unit
Introduction/Hypothesis: Reported re-intubated rates of critically ill trauma patients range as high as 23%. This may be associated with additional physiologic stress for the critically ill patient. Little is known about the outcomes in this population, which limits informed discussions of recurrent respiratory failure and potential re-intubation with patients and families. Our goal was to characterize the outcomes after re-intubation in the trauma population of our institution.
Methods: Retrospective review was performed to evaluate all intubated critical care patients from January 1st, 2011 to December 31st, 2019. Inclusion criteria included trauma extubated patients, that required re-intubation. Patient demographics, including new injury severity score (NISS) and outcomes including, in-hospital mortality and after 1-year mortality were collected.
Results: 175 patients required re-intubation in our trauma ICU. 68 female and 107 male. Average age was 78.9. With the exception of one gunshot wound and one chainsaw injury, all patients suffered blunt trauma. Fall was the most common mechanism 48%, while motor vehicle accidents accounted for 28% of patients. Mean NISS was 23.1 and 67.1% of patients required tracheostomy. Palliative care team was involved in 29.3% of patients. A total of 36 patients (20.3%) were discharged to long term care facilities, 17.2% of patients were discharged to rehabilitation or step-down care centers, and 8 patients (4.7%) were discharged home. In hospital mortality was 57.8%. 137 patients were followed up after at least 1-year and the mortality was as high as 80.6%.
Conclusion: After blunt trauma, patients who required re-intubation during their ICU stay are at high risk of death within 1-year of presentation. Such information may be useful in counselling patient and family members about goals of care.