Extubating trauma patients in the emergency department

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Critical Care

Background:

• Trauma patients often require endotracheal intubation for airway management or imaging.
• Extubation in the emergency department (ED) occurs when trauma workup is negative.
• The safety and timing of ED extubation and discharge remain unclear.

Purpose of the Study:

• To identify adverse outcomes associated with extubating trauma patients in the ED.
• To evaluate the safety of discharging clinically stable trauma patients after ED extubation.

Main Methods:

• Retrospective review of intubated and extubated trauma patients at a level 1 trauma center (Jan 2014 - Dec 2017).
• Primary outcome: post-extubation complications (desaturation, emesis, aspiration, reintubation).
• Secondary outcomes: disposition, observation duration, ED length of stay, 72-hour return visits.

Main Results:

• 59 eligible patients, 95% with blunt trauma.
• One patient (1.7%) required reintubation and developed aspiration pneumonia.
• 71% discharged from ED after a mean 5.8-hour observation; 0% returned within 72 hours with extubation-related complications.

Conclusions:

• ED extubation and discharge of trauma patients with negative workups appear safe with brief observation.
• Development of specific extubation and discharge criteria is recommended.
• Larger, prospective studies are needed for further validation.