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Research Snapshot Theater: Trauma/Quality and Patient Safety, Adult

Unplanned Extubation in Critically Ill Trauma Patients: Risk Factors and Clinical Outcomes

Tuesday, March 24, 2026
10:00 AM - 11:00 AM Central Time
Location: Connections Central - RST 11

  • Vivek Pamulapati, MD, MS (he/him/his)

    UNLV School of Medicine, Nevada

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • IG

    Ivan Gonzalez, BS

    Medical Student
    University of Nevada Las Vegas School of Medicine

    Disclosure information not submitted.

  • BB

    Brent Blackwell, MD

    General Surgery Resident
    University of Nevada Las Vegas School of Medicine

    Disclosure information not submitted.

  • Deborah A. Kuhls, MD, FRCST(Hon)

    University of Nevada Las Vegas School of Medicine, NV

    Disclosure information not submitted.

  • AM

    Allison McNickle, MD, FACS

    Assistant Professor and Acute Care Surgery Fellowship Program Director
    University of Nevada Las Vegas School of Medicine

    Disclosure information not submitted.

Introduction: Unplanned extubation (UE) is a widely recognized adverse event among mechanically ventilated (MV) intensive care unit (ICU) patients that can result in prolonged hospitalization and increased mortality. The risk factors and clinical outcomes of UE for critically ill trauma patients remain poorly understood due to high prevalence of varying injury patterns, agitation, and severe pain. This study aims to address the knowledge gap in the risk factors and clinical outcomes of UE among adult trauma patients requiring MV.


Methods: A retrospective analysis of a level 1 trauma center registry was performed on adult trauma patients requiring MV in a specialized trauma ICU between 1/1/2022 and 12/31/2024. Registry data was assessed for patient characteristics, injury types, and outcome measures. Chart review was used to identify patients with UE. Statistical analysis was performed comparing patients with UE to those without UE using Mann-Whitney U tests, Fisher's exact tests, and multivariable logistic regression with significance defined as p< 0.05.


Results: A total of 1,233 intubated trauma patients were identified with 96 patients (7.8%) undergoing UE. On multivariate analysis lower age (OR 0.98/year, p=0.01) and presence of traumatic brain injury (OR 2.03, p=.008) were significantly associated with UE when controlling for sex, race, comorbidities, substance abuse, blunt vs penetrating trauma, injury severity score, and Glasgow Coma Scale. UE was not associated with a significant difference in hospital length of stay, ICU length of stay, ventilator days, ventilator associated pneumonia (VAP), or need for tracheostomy. In-hospital mortality was significantly lower in the UE group (3% UE vs 24.6% no UE, p< 0.001). Among the UE patients 21.9% (n=21) of patients required reintubation within 48 hours and 12.5% (n=12) underwent tracheostomy.


Conclusions: Among traumatically injured adults requiring intubation, UE is associated with lower age and presence of TBI. There was no association between UE and increased ventilator days, ICU / hospital length of stay, need for tracheostomy, or VAP. Mortality was significantly lower in the UE group which may reflect a younger sub-population. Further study is necessary to understand the impacts of modifiable factors including sedation protocols and monitoring.