The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: A systematic review and meta-analysis

•Reintubation imposes threat on survival as well as raising the risk of acquisition of ventilator-associated pneumonia.•The association between reintubation and mortality is differential in planned extubation population and unplanned extubation population.•Extubation failure brings greater harm in exclusive cardiac surgery population than general population.•Particular attention should be paid in mechanically ventilated patients who ever experienced cardiac surgery and unplanned extubation.

ObjectivesThis meta-analysis summarized the risks that reintubation impose on ventilator-associated pneumonia (VAP) and mortality.BackgroundExtubation failure increases the probability of poor clinical outcomes pertaining to mechanical ventilation.MethodsLiterature published during a 15-year period was retrieved from PubMed, Web of Knowledge databases, the Embase (Excerpa Medica database), and the Cochrane Library. Data involving reintubation, VAP, and mortality were extracted for a meta-analysis.ResultsForty-one studies involving 29,923 patients were enrolled for the analysis. The summary odds ratio (OR) between VAP and reintubation was 7.57 (95% confidence interval [CI] = 3.63–15.81). The merged ORs for mortality in hospital and intensive care unit were 3.33 (95% CI = 2.02–5.49) and 7.50 (95% CI = 4.60–12.21), respectively.ConclusionsReintubation can represent a threat to survival and increase the risk of VAP. The risk of mortality after reintubation differs between planned and unplanned extubation. Extubation failure is associated with a higher risk of VAP in the cardiac surgery population than in the general population.