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www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: The decision to extubate patients often reflects the culture of the institution and/or extubation protocols. Fluid balance, ejection fraction and underlying pulmonary disease while not part of these protocols, may factor in the success of attempts. The objective of this study was to retrospectively describe the reintubation rate and to compare the effects of fluid balance, ejection fraction and effect of underlying pulmonary disease of patients requiring reintubation within 48 hours to a random sample of successfully extubated patients during the same time period. Methods: The APACHE Outcomes Database was used to generated a list of patients successfully extubated and patients reintubated within 48 hours from June 2016 through March 2017. One thousand two hundred and twenty patients were extubated and 101 (8.2%) required reintubation. Patients who were self extubated or had care withdrawn were excluded. The following demographic and patient data were collected: age, gender, BMI, duration of mechanical ventilation, history of obstructive sleep apnea (OSA), COPD, and asthma, ejection fraction (echocardiogram done during current hospitalization) and net fluid balance up until the day of extubation. The proportion of patients with EF> 50%, fluid balance more than 5 liters positive, greater than 5 days mechanical ventilation and a history of OSA/COPD/asthma were compared using the Chi Square Test. Results: Patients reintubated within 48 hours(n = 101) vs. Successfully extubated (n = 204): EF mean(57.7 vs. 57.3). EF > 50% [73/85 (85.8%) vs. 99/124 (79.8%):not significant]. Fluid balance(mean) (4077 vs. 3407). Fluid balance > positive 5 liters (n)[41(40.6%) vs. 56(27.4%)p < 0.05]. Duration of mechanical ventilation(mean) (4.5 ± 3.3 vs. 3.9 ± 5.1). Mechanical Ventilation > 5 days (n)[(29 vs. 36)p < 0.05]. OSA/COPD/Asthma (n)(30 vs. 69:not significant). Age(mean)(SD)(59.7 ± 16.4 vs. 54.9 ± 19.5). Gender M/F (n) (52/49 vs. 105/99). % male(51.5% vs. 51.5%). BMI (mean) (SD) (29.6 ± 9.8 vs. 30.24 ± 9.4) Conclusions: The reintubation rate in this study was 8.2%. Based on this analysis, a significantly higher proportion of patients with a positive fluid balance of at least 5 liters and patients who required greater than 5 days of mechanical ventilation required reintubation. Underlying pulmonary disease and ejection fraction did not appear to affect the reintubation rate. Further study validating these findings appears warranted.