Should we avoid extubating at nighttime?

Many intensive care units try to avoid extubations at nighttime due to the fear of potentially fatal complications and possibly higher reintubation rates. However, it might actually be favourable to extubate patients as soon as possible, as this might have a positive impact on ventilation related complications and patient’s length of stay. Interestingly nobody has ever looked at this special topic so far.

Tischenkel BR et al. have now looked at this topic in a retrospective cohort study of two hospitals in the state of New York. In this paper, published in the Journal of Intensive Care Medicine this month, they looked at a total of 2240 patients which were extubated in intensive care units over the period of almost 2 years. As a result they could show that nighttime extubations did not have a higher likelihood of reintubation, length of stay or mortality compared to those during the day. They conclude that patients should be extubated as soon as they meet parameters in order to potentially decrease complications of mechanical ventilation. These data, they say, do not support delaying extubations until daytime.

I fully agree… as long as there is somebody in the unit able to deal with potentially deleterious complications!

Tischenkel BR et al. J Intensive Care Med April 24, 2014


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