Extubation failure in a tertiary Australian ICU: Incidence, risk factors, and outcomes from a retrospective audit

BACKGROUND: Extubation failure (ExF), defined as reintubation within 72 h of planned extubation, is a key quality indicator in intensive care. International incidence varies from 2 to 25%, but Australian data are limited. OBJECTIVES: To determine ExF incidence, risk factors, causes, and outcomes in a tertiary ICU, with emphasis on modifiable factors such as delirium and fluid balance. METHODS: Retrospective audit of 2761 elective extubations (Jan 2022-Jan 2024) at Westmead ICU. ExF was unplanned reintubation within 72 h. Data were retrieved from eRIC and ANZICS APD. Baseline characteristics, risk factors, and outcomes were compared using univariate analyses. RESULTS: ExF occurred in 52 patients (1.8%). ExF was associated with delirium (48%vs 12%; OR 6.79), positive fluid balance (+1.8 L vs -0.3 L), longer ICU stay (12.8 vs 3.0 d), and higher mortality (21%vs 11%). Causes included excessive secretions/aspiration (32%), stridor (18%), and hypoxia (15%). CONCLUSION: ExF incidence was low but associated with high morbidity and mortality. Delirium and fluid balance were the most significant modifiable risk factors.