As residents we were always taught not to extubate at night.
This JAMA cohort study examined the frequency of overnight extubations and their outcomes. This study looked at 97 844 patients in US intensive care units who were intubated. They found 20.1% were extubated at night. The study extended from January 1, 2015, to July 5, 2016. Overnight extubation was defined as occurring between 7 pm to 6:59 am. Outcomes measures were reintubation, hospital mortality, and length of stay (LOS)
For mechanical ventilation (MV) duration of less than 12 hours, reintubation rates were similar for overnight and daytime extubations (5.9% and 5.6%, but mortality was increased for patients undergoing overnight extubation (ICU, 5.6% vs 4.6%, P = .03; hospital, 8.3% vs 7.0%, P = .01). The ICU LOS was shorter for overnight vs daytime extubations (median [interquartile range], 1.1 [0.8-2.3] vs 1.4 [0.9-2.5] days; P < .001), and hospital LOS was similar (median [interquartile range], 7.0 [4.0-12.0] vs 7.0 [3.0-12.0] days; P = .03). Patients with MV duration of at least 12 hours who underwent overnight extubation had more frequent reintubation in the ICU (14.6% vs 12.4%; P < .001) and higher mortality in the ICU (11.2% vs 6.1%; P < .001) and in the hospital (16.0% vs 11.1%; P < .001), with no differences in LOS.