Incidence, risk factors, and outcomes of unplanned extubation in adult patients in a resource-limited teaching hospital in the Philippines: a cohort study

Abstract

Objective We aimed to determine the incidence, risk factors, and outcomes of unplanned extubation among adult patients. Methods We conducted a prospective cohort study of adult intubated patients admitted to the charity wards of a government tertiary teaching hospital in the Philippines. Patients managed in both intensive care and nonintensive care settings were included. Patients were followed-up until discharge or until seven days postextubation. Results The outcomes of the 191 included patients were planned extubation (35%), unplanned extubation (19%), death (39%), and discharge against advice (7%). Competing risk regression showed that male sex (Crude OR: 2.25, 95%CI: 1.10 - 4.63) and age (Crude OR 0.976, 95%CI: 0.957 - 0.996) were significant baseline factors. The night shift (Crude OR: 24.6, 95%CI: 2.87 - 211) was also consistently associated with more unplanned extubations. Among postextubation outcomes, reintubation (unplanned extubation: 61.1% versus planned extubation: 25.4%), acute respiratory failure (unplanned extubation: 38.9% versus planned extubation: 17.5%), and cardiovascular events (unplanned extubation: 8.33% versus planned extubation: 1.49%) occurred significantly more often among the unplanned extubation patients. Admission in an intensive care unit was not associated with a lower risk of unplanned extubation (Crude OR 1.15, 95%CI: 0.594 - 2.21). Conclusion Many intubated patients had unplanned extubation. Patients admitted in nonintensive care unit settings did not have significantly higher odds of unplanned extubation.

Magnitude and associated factors of unplanned extubation in intensive care unit: A multi-center prospective observational study

“…In this study, the magnitude of unplanned extubation was 19.74% which was in the range of 0.5%–35.8% reported in the systematic literature review [ 10 ]. The result we found on the magnitude of unplanned extubation was in line with the study which was done in the Philippines, unplanned extubation rate of 19% [ 9 ], and the research done in Taiwan with an incidence rate of 22.5% [ 17 ]. On the other hand, the result was inconsistent with research done in British (4.47%), Belgium (4.2%), and Spain (10%) [ 18 ].…”

“…The possible reason for this Addis Ababa governmental hospitals are the area of trainee and was loaded with junior resident which has a significant contribution to the incidence of unplanned extubation evidenced by our data. This was supported by the research done in Egypt in 2019 patients managed by junior residents were more likely to increase the probability of unplanned extubation [ 9 ]. The other reason most of them used a case-control study design,cross-sectional study design, they were get secondary data from previous records which has the chance of losing the case.…”

“…Prevention of unplanned extubation is important since it may lead to serious complications, like airway trauma, compromised hemodynamic and respiration [ 5 ], prolonged duration of mechanical ventilation, and prolonged hospital stay [ 6 , 7 ], which leads to high mortality, morbidity and inefficient use of resource [ 8 ]. The incidence of reintubation and cardiovascular accidents after unplanned extubation were 61.1% and 8.33% respectively in Philippines general hospitals [ 9 ].…”

Risk factors for reintubation and mortality among patients who had unplanned extubation

“…required reintubation. Moreover, Phoa et al 9 found that the rate of reintubation after failed UE was 58.3%, out of which 71.4% had immediate reintubation, and Uy et al 12 reported that reintubation was necessary for 61.1% of patients with UE, which was much higher than in patients with planned extubation (25.4%). In a review by Bambi et al,23 the reintubation rate ranged from 1.81% to 88%.…”

“…[2][3][4][5][6][7][8][9] Not every patient who had UE has failed extubation but failed UE requiring reintubation could be associated with several adverse events, such as aspiration pneumonia, bronchospasm, arrhythmia, respiratory failure, or even sudden cardiac arrest. [10][11][12][13][14] Moreover, patients who had UE may be required to prolong their hospital or ICU stay and MV duration. [14][15][16][17][18] Most importantly, UE can adversely affect the patients' survival rates.…”