The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: A systematic review and meta-analysis

Abstract Objectives This meta-analysis summarized the risks that reintubation impose on ventilator-associated pneumonia (VAP) and mortality. Background Extubation failure increases the probability of poor clinical outcomes pertaining to mechanical ventilation. Methods Literature published during a 1...

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Bibliographic Details
Published in:Heart & lung 2016-07, Vol.45 (4), p.363-371
Main Authors: Gao, Fan, MM, Yang, Li-Hong, MB, He, Hai-Rong, MM, Ma, Xian-Cang, MD, PhD, Lu, Jun, MD, PhD, Zhai, Ya-Jing, BS, Guo, Li-Tao, MM, Wang, Xue, MD, PhD, Zheng, Jie, MM
Format: Article
Language:English
Subjects:
Airway Extubation - methods
Cardiac Surgical Procedures
Cardiovascular
Critical Care
Extubation failure
Global Health
Humans
Intensive Care Units
Intubation, Intratracheal - methods
Meta-analysis
Mortality
Odds Ratio
Pneumonia, Ventilator-Associated - mortality
Pneumonia, Ventilator-Associated - therapy
Postoperative Complications
Pulmonary/Respiratory
Reintubation
Respiration, Artificial
Risk assessment
Risk Factors
Survival Rate - trends
Ventilation
Ventilator-associated pneumonia
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Summary:Abstract Objectives This meta-analysis summarized the risks that reintubation impose on ventilator-associated pneumonia (VAP) and mortality. Background Extubation failure increases the probability of poor clinical outcomes pertaining to mechanical ventilation. Methods Literature published during a 15-year period was retrieved from PubMed, Web of Knowledge databases, the Embase (Excerpa Medica database), and the Cochrane Library. Data involving reintubation, VAP, and mortality were extracted for a meta-analysis. Results Forty-one studies involving 29,923 patients were enrolled for the analysis. The summary odds ratio (OR) between VAP and reintubation was 7.57 (95% confidence interval [CI] = 3.63–15.81). The merged ORs for mortality in hospital and intensive care unit were 3.33 (95% CI = 2.02–5.49) and 7.50 (95% CI = 4.60–12.21), respectively. Conclusions Reintubation can represent a threat to survival and increase the risk of VAP. The risk of mortality after reintubation differs between planned and unplanned extubation. Extubation failure is associated with a higher risk of VAP in the cardiac surgery population than in the general population.
ISSN:0147-9563
1527-3288
DOI:10.1016/j.hrtlng.2016.04.006