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  • Title: Factors Associated With Re-Intubation Within 14 Days After Ventilator Liberation.
    Author: Chu CC, Liu CJ, Yen SM, Chou WY, Kung PT, Tsai YS, Tsai WC.
    Journal: Respir Care; 2017 Dec; 62(12):1557-1564. PubMed ID: 28974646.
    Abstract:
    BACKGROUND: According to Taiwan's integrated delivery system policy, ventilator-dependent patients are successfully liberated from mechanical ventilation in accordance with step-down care. However, premature discharge affects the 14-d readmission quality index. Therefore, we explored the risk and related factors of subjects liberated from mechanical ventilation who were re-intubated within 14 d. METHODS: This retrospective study analyzed a cohort of ventilator-dependent subjects 17 y of age and older using a population-based database from the Taiwan National Health Research Institutes Database from 2006 to 2010. Chi-square test and logistic regression analyses were used to explore whether subjects liberated from mechanical ventilation were re-intubated within 14 d and to investigate the related factors. RESULTS: A total of 15,840 ventilator-dependent subjects were liberated from mechanical ventilation, and 449 subjects were re-intubated within 14 d; the total re-intubation rate was 2.83%. The factors related to a higher risk of re-intubation were also the reasons for ventilator use, including complications, hospital accreditation level, and the ventilator weaning care stage. A higher risk of re-intubation was identified in subjects with COPD (odds ratio [OR] 1.32, 95% CI 1.02-1.7, P = .035) or pneumonia (OR 1.4, 95% CI 1.07-1.86, P = .02) and in subjects who stayed at a district hospital (OR 3.53, 95% CI 2.48-5.01, P < .001). Liberation from mechanical ventilation in the respiratory care ward and home respiratory care were associated with the highest risk of re-intubation, which was 2.32 times that of ICU subjects (P < .001). CONCLUSIONS: Factors associated with re-intubation within 14 d after ventilator liberation are related to the level and quality of the care setting; thus, to prevent re-intubation, more attention should be paid to higher-risk ventilator-dependent subjects after they are liberated from mechanical ventilation.
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