Decreasing failed extubations with the implementation of an extubation checklist

• Published in: The American journal of surgery 2019-06, Vol.217 (6), p.1072-1075
• Main Authors: Bobbs, Melanie, Trust, Marc D., Teixeira, Pedro, Coopwood, Ben, Aydelotte, Jayson, Tabas, Irene, Ali, Sadia, Brown, Carlos V.R.
• Format: Article
• Language: English
• Subjects: Abdomen; Adolescent; Adult; Age; Aged; Aged, 80 and over; Airway Extubation - methods; Airway Extubation - mortality; Airway Extubation - standards; Airway Extubation - statistics & numerical data; Anesthesia; Blood pressure; Checklist; Coma; Demographics; Evidence-based medicine; Extubation; Female; Hospital costs; Humans; Hypoxia; Intensive care; Intensive Care Units; Intubation; Length of Stay - statistics & numerical data; Male; Mechanical ventilation; Middle Aged; Mortality; Patients; Rehabilitation; Respiratory therapy; Retrospective Studies; Studies; Trauma; Traumatic brain injury; Treatment Outcome; Ventilation; Ventilator Weaning - methods; Ventilator Weaning - mortality; Ventilator Weaning - standards; Ventilator Weaning - statistics & numerical data; Ventilators; Wounds and Injuries - mortality; Wounds and Injuries - therapy; Young Adult
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.02.028

Failed extubation has been shown to increase ICU stay, transfers to rehabilitation facilities, and mortality. The purpose of this study was to assess the differences in rates of failed extubation before and after implementation of an extubation checklist. We performed a retrospective study from January 2013–April 2017 on adult trauma patients (age 18–89) who were admitted to the ICU and required mechanical ventilation. Patients were grouped before and after implementation of an extubation checklist and compared. A total of 993 patients were included in this study. After checklist implementation, significantly fewer patients required reintubation compared to those prior to checklist (7% vs 3%, p = 0.005). There was no difference in mortality (20% vs 21%, p = 0.54) or hospital length of stay between the two groups (16 days vs 15 days, p = 0.16). Our study reveals that implementing an extubation checklist is associated with fewer failed extubations. •Failed extubations are associated with poor outcomes.•Effects of extubation checklists on trauma populations are not well described.•Our study compares two trauma populations before and after an extubation checklist.•An extubation checklist is associated with a decrease in failed extubations.•This study revealed no difference in hospital length of stay or mortality.