Extubating Patients From Ventilators At Night Linked To Higher Mortality

MedicalResearch.com Interview with:

Hayley B. Gershengorn, MD Associate Professor, Albert Einstein College of Medicine Attending Physician, Montefiore Medical Center Bronx, NY 10467

Dr. Hayley Gershengorn

Hayley B. Gershengorn, MD
Associate Professor, Albert Einstein College of Medicine
Attending Physician, Montefiore Medical Center
Bronx, NY 10467

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Little was previously known about the timing of extubations for mechanically ventilated intensive care unit patients or whether extubating patients overnight is safe. In this retrospective cohort study of mechanically ventilated intensive care unit adult patients in the United States, 20.1% were extubated overnight. Overnight extubation was associated with significantly higher hospital mortality.

MedicalResearch.com: What should readers take away from your report?

Response: Overnight extubation is not common and is associated with worse outcomes for critically ill patients. Although our study cannot prove causality, our findings raise serious concerns about the routine practice of overnight extubation for many intensive care unit patients.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Given the complications of mechanical ventilation (e.g., pneumonia, delirium, weakness), there is good reason to move to extubate people as soon as possible. Our study raises concerns, though, that while it may be safe (or even beneficial) to extubate some patient subgroups (e.g., post-cardiac surgery patients) overnight, for many patients, this practice may confer harm. Prospective controlled study of the impact of overnight extubation on clinically relevant outcomes (including mortality) is the only way to demonstrate that overnight extubations cause morbidity and mortality.

In 2005, approximately 800,000 patients received mechanical ventilation in the U.S. and the incidence of mechanical ventilation has steadily increased over the past 2 decades. Given the scope of this issue, therefore, it is imperative that we determine conclusively how best to care for these patients weighing both the upsides of earlier extubation and the potential downsides of extubation overnight.

MedicalResearch.com: Is there anything else you would like to add?

Response: I would like to stress that, as a retrospective study, the results of our work are best viewed as discussion stimulating and hypothesis generating. Prospective study is needed before we can conclude that overnight extubation causes harm to patients.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Nighttime Extubations Are Associated with Worse Outcomes for U.S. Intensive Care Unit Patients
H.B. Gershengorn1, D.C. Scales2, A. Kramer3, H. Wunsch2
1Albert Einstein College of Medicine; Montefiore Medical Center – Bronx, NY/US, 2Sunnybrook Hlth Sciences Ctr – Toronto, ON/CA, 3Prescient Healthcare Consulting – Charlottesville, VA/US
Publication
Association Between Overnight Extubations and Outcomes in the Intensive Care Unit
Previously presented at The American Thoracic Society conference

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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