C. Meschia1, M. Crandall1, D. Skarupa1, R. Warner1 1University of Florida Jacksonville, Department Of Surgery, Jacksonville, FL, USA
Introduction:
Nighttime extubation in traditionally staffed Intensive Care Units (ICU) is associated with increased mortality. The Critical Care Resource Intensivist (CCRI) Model is a cohort of multi-disciplinary fellowship trained intensivists that provide in-house coverage overnight. Prior to implementation of CCRI, nighttime coverage was provided by the on-call acute care surgeon. The impact of overnight intensivist staffing on ICU patients’ outcomes remains a question of debate. This study sought to analyze the impact of the CCRI model on the safety of nighttime extubation.
Methods:
A single-center retrospective cohort analysis of ICU patients at a Level 1 Trauma Center from March 2018 to June 2022. Statistical analysis was performed using chi-squared and two sample t-tests. The primary outcome studied was number of nighttime extubations with secondary outcomes of reintubation within 24-hrs, hospital length of stay (LOS), and ICU LOS.
Results:
A total of 1045 pts were included with 422 in the pre-CCRI cohort and 623 in the post-CCRI. Extubation occurred more frequently overnight (8pm-8am) after the implementation of CCRI (preCCRI 422 vs postCCRI 623, p=0.02) with no difference in reintubation within 24-hrs (p=0.88) or ICU LOS (p=0.19). Despite increased nighttime extubations, in-hospital mortality remained unchanged (preCCRI 105 vs postCCRI 130, p=0.13).
Conclusion:
The impact of nighttime staffing of the ICU by in-house intensivist has yet to be fully elucidated. While nighttime extubation can advance patient care it has previously been shown to come with a cost of patient safety in terms of mortality and re-intubation. The CCRI Model allows increased frequency of total extubations, including nighttime extubations, without compromise of patient safety.
