B104-12 Extubation Trends Across Days of the Week in Intensive Care Units

Abstract Rationale Liberation from mechanical ventilation (MV) should ideally be guided solely by patient readiness. ICU operations may be influenced by factors such as physician staffing patterns and rotation schedules. Many ICUs operate with reduced staffing on weekends, and physician teams often begin new rotations on Mondays, when familiarity with patients is limited. These structural factors may unintentionally delay extubation and prolong the duration of MV. The objective of this study was to examine the distribution of extubations across the days of the week to determine whether such non-clinical factors systematically influence extubation practices. Methods We conducted a retrospective analysis of 15,294 extubations in adult patients (16 years) across the WMC Critical Care system between October 2015 and December 2024. Extubations occurring between January 2020 and December 2021 were excluded due to the impact of the COVID-19 pandemic on ICU operations. None of the ICUs included in the analysis used standardized weaning or extubation protocols during this period. We examined the distribution of extubations by day of the week and employed chi-square goodness-of-fit tests to compare observed versus expected frequencies under the null hypothesis of equal distribution. Specific comparisons included: (1) Mondays versus other weekdays, (2) early-week (Monday-Tuesday) versus late-week (Thursday-Friday), and (3) weekends versus weekdays. Results Extubations were not evenly distributed throughout the week. Mondays had significantly fewer extubations compared with the average of the other weekdays (1,875 vs. 2,503; p 0.0001). Similarly, extubations early in the week (Monday-Tuesday) were significantly fewer than those later in the week (Thursday-Friday) (4,300 vs. 4,984; p 0.0001). The most striking disparity was seen on weekends, when extubations were markedly lower than on weekdays (mean 1,703.5 vs. 2,377.4; p 0.0001). Conclusions Extubations in the ICU demonstrate a systematic pattern, with significantly fewer extubations occurring at the beginning of the week and on weekends. This suggests that non-clinical organizational factors, rather than patient readiness alone, are influencing extubation timing. The lower rate of extubations on weekends is likely related to reduced manpower and a more cautious approach by physicians when fewer staff members are available to address complications. The lower rate on Mondays and Tuesdays may reflect limited familiarity of new ICU teams with patients at the start of their rotation, resulting in a tendency to delay such decisions until later in the week. These findings highlight the importance of recognizing how structural and scheduling factors inherent to ICU operations can affect patient care. This abstract is funded by: None