Reintubation

Reintubation is the reinsertion of an endotracheal tube after removal or failed extubation, performed when the patient cannot maintain airway patency or adequate gas exchange following extubation. It is a common event in intensive care and perioperative settings.

Indications include airway obstruction from edema or secretions, inability to protect the airway, persistent or worsening hypoxemia or hypercapnia after extubation, respiratory failure, or hemodynamic instability. Reintubation is sometimes categorized as early (within 24 hours) or late (after 24 hours), with early failure often driven by airway edema or respiratory insufficiency and late failure more frequently related to weaning failure, infection, or fluid overload.

Risk factors include advanced age, obesity, chronic lung disease, neuromuscular weakness, coma or altered mental status, prolonged prior ventilation, multiple failed spontaneous breathing trials, and difficult airway history. Complications of reintubation include aspiration, hypoxemia, hypotension, arrhythmias, airway trauma, ventilator-associated pneumonia, and increased mortality risk. Reintubation is also associated with longer ICU and hospital stays and greater resource use.

Management requires rapid airway assessment, optimization of oxygenation and ventilation, and preparation for reintubation with appropriate personnel and equipment. Techniques often involve preoxygenation, suctioning, and rapid sequence intubation, with consideration of videolaryngoscopy or alternative airway devices in difficult airways. Prevention focuses on careful extubation readiness assessment, spontaneous breathing trials, management of airway edema, and post-extubation support such as high-flow oxygen or noninvasive ventilation in high-risk patients.