reintubated

Reintubation refers to the placement of an endotracheal tube again in a patient who has previously been extubated, in order to restore airway protection and mechanical ventilation. It is performed when a patient who has been weaned from a ventilator cannot sustain adequate ventilation or airway patency, or when airway protection is compromised.

Indications for reintubation include acute respiratory failure after extubation, recurrent airway obstruction, severe hypoxemia or hypercapnia, altered mental status or agitation impairing airway protection, excessive secretions with poor clearance, or hemodynamic instability. Reintubation can be planned in some cases following a failed weaning trial, but it is often unplanned and may occur within hours to days after extubation.

Risk factors and prevalence vary by population. Reintubation rates after extubation failure are commonly reported in the range of roughly 5% to 15% in general ICU populations, with higher rates in patients with chronic lung disease, obesity, neuromuscular impairment, or high severity of illness. Reintubation is associated with worse outcomes, including longer intensive care unit and hospital stays, more ventilator days, and higher mortality in some cohorts. It may also reflect the underlying severity of illness or complications from prior weaning attempts.

Management involves rapid assessment and preparation of airway equipment, followed by reintubation when indicated. The procedure is typically performed with rapid sequence induction to minimize aspiration risk, under close monitoring of oxygenation, ventilation, and hemodynamics. Postintubation care emphasizes appropriate ventilator settings, airway protection, and addressing reversible causes such as bronchospasm, edema, secretions, or infection.

Prevention focuses on careful weaning protocols, adequately timed spontaneous breathing trials, and addressing risk factors for extubation failure, such as airway edema, poor cough strength, or inadequate secretion management.