Reintubation in the ICU: A Prospective Observational Study of Its Impact on Recovery Outcomes and Mortality.

Background Extubation is an important step in the recovery of critically ill patients, but some patients deteriorate after removal of the endotracheal tube and require reintubation. Extubation failure can prolong intensive care and is associated with poor outcomes. This study examined the factors associated with reintubation and the clinical outcomes of patients who failed planned extubation. Methods We prospectively followed adult patients undergoing planned extubation in the adult ICU of a tertiary care hospital between June 2025 and June 2026. Patients were observed for 72 hours after extubation, and those requiring reintubation during this period were considered to have experienced extubation failure. Demographic, clinical, physiological, and laboratory characteristics were compared between patients who remained successfully extubated and those who required reintubation. Factors associated with reintubation and in-hospital mortality were examined using multivariable logistic regression. Results A total of 180 patients were included, of whom 27 (15.0%) required reintubation within 72 hours. The patients who required reintubation were older and had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) and Rapid Shallow Breathing Index (RSBI) scores, while their Glasgow Coma Scale (GCS) scores and serum albumin levels were lower. Positive fluid balance, emergency admission, congestive heart failure, chronic lung disease, and acute kidney injury requiring renal replacement therapy were also more frequent in this group. Reintubation was associated with a longer duration of mechanical ventilation, longer ICU and hospital stays, and higher rates of ventilator-associated pneumonia and tracheostomy. ICU and in-hospital mortality were also considerably higher among patients who required reintubation. After adjustment for other factors, APACHE II score >20, GCS <12, RSBI >105, serum albumin <3.5 g/dL, positive fluid balance >1 L, and mechanical ventilation >7 days were associated with reintubation. Reintubation was strongly associated with in-hospital mortality (adjusted OR, 5.84; 95% CI, 2.31-14.78; P < 0.001). Conclusions In this cohort, patients who required reintubation after planned extubation had a substantially more difficult clinical course and a higher risk of death. Greater illness severity, poor respiratory reserve, low serum albumin, positive fluid balance, and prolonged mechanical ventilation were associated with extubation failure. Identifying these features before extubation and maintaining close observation after extubation may help clinicians recognize patients at higher risk of deterioration.