Age is an Important Predictor of Failed Unplanned Extubation

Chen, Chin Ming; Chan, Khee Siang; Fong, Y.; Hsing, Shu Chen; Cheng, Ai Chin; Sung, Mei Yi; Su, Mei Yu; Cheng, Kuo Chen

doi:10.1016/s1873-9598(10)70035-1

Cited by 18 publications

(16 citation statements)

References 23 publications

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“…Reintubation after UE should not be required in all cases; we reported a reintubation rate after UE of approximately 40%, and the reported reintubation rates after UE vary widely (31%-70%) among researchers 3 6 12 21 . Because reintubation after UE is not mandatory, it is important to recognize the factors associated with extubation failure in these patients.…”

Section: Discussionmentioning

confidence: 80%

Unplanned Extubation in Patients with Mechanical Ventilation: Experience in the Medical Intensive Care Unit of a Single Tertiary Hospital

et al. 2015

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BackgroundPotentially harmful unplanned extubation (UE) may occur in patients on mechanical ventilation (MV) in an intensive care unit (ICU) setting. This study aimed to evaluate the clinical characteristics of UE and its impact on clinical outcomes in patients with MV in a medical ICU (MICU).MethodsWe retrospectively evaluated MICU data prospectively collected between December 2011 and May 2014.ResultsA total of 468 patients were admitted to the MICU, of whom 450 were on MV. Of the patients on MV, 30 (6.7%) experienced UE; 13 (43.3%) required reintubation after UE, whereas 17 (56.7%) did not require reintubation. Patients who required reintubation had a significantly longer MV duration and ICU stay than did those not requiring reintubation (19.4±15.1 days vs. 5.9±5.9 days days and 18.1±14.2 days vs. 7.1±6.5 days, respectively; p<0.05). In addition, mortality rate was significantly higher among patients requiring reintubation than among those not requiring reintubation (54.5% vs. 5.9%; p=0.007). These two groups of patients exhibited no significant differences, within 2 hours after UE, in the fraction of inspired oxygen, blood pressure, heart rate, respiratory rate, and pH.ConclusionAlthough reintubation may not always be required in patients with UE, it is associated with a poor outcome after UE.

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Section: Discussionmentioning

confidence: 80%

Unplanned Extubation in Patients with Mechanical Ventilation: Experience in the Medical Intensive Care Unit of a Single Tertiary Hospital

et al. 2015

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“…In contrast, the mortality was significantly lower in UE patients being weaned before extubation. Our previous study showed that the rate of liberation form MV over 48 hours among UE patients were higher in those MV modes were setting in weaning condition (62.7%) as compared to those who were not (37.7%), and those successful weaning UE patients certainly had a significantly lower in-hospital mortality than failed UE patients (11.1% vs. 23.1%) 15 . Because these patients should be ready for extubation, if it occurs a little earlier than anticipated, it might not affect outcome.…”

Section: Discussionmentioning

confidence: 91%

“…In our ICU, we would opiate agents including fentanyl or morphine as analgesia and benzodiazepines, including midazolam, lorazepam or propofol as sedative agents to keep patients being not agitated and comfortable according to the sedative protocol (appendix 1) 15 . Additionally, haloperidol can be prescribed for delirium and muscle relaxant including pancuronium or atracurium can be added if the above treatment failed.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, patients who undergo UE will have their MV, ICU stay, and hospital stay prolonged 6 , 11 – 13 . The hospital mortality rate of patients who undergo UE can range from 10% to 25%, and even higher for patients who require reintubation 6 , 12 , 14 , 15 . Although many studies 2 , 8 , 9 , 11 , 12 , 16 – 19 have mentioned UE-associated mortality, most of them focus on a comparison of mortality rates between patients who do and do not undergo UE.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic factors and outcomes of unplanned extubation

Chao

Sung

Cheng

et al. 2017

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This study investigated the prognostic factors and outcomes of unplanned extubation (UE) in patients in a medical center’s 6 intensive care units (ICUs) and calculated their mortality risk. We retrospectively reviewed the medical records of all adult patients in Chi Mei Medical Center who underwent UE between 2009 and 2015. During the study period, there were 305 episodes of UE in 295 ICU patients (men: 199 [67.5%]; mean age: 65.7 years; age range: 18–94 years). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16.4, mean therapeutic intervention scoring system (TISS) score was 26.5, and mean Glasgow coma scale score was 10.4. One hundred thirty-six patients (46.1%) were re-intubated within 48 h. Forty-five died (mortality rate: 15.3%). Multivariate analyses showed 5 risk factors—respiratory rate, APACHE II score, uremia, liver cirrhosis, and weaning status—were independently associated with mortality. In conclusion, five risk factors including a high respiratory rate before UE, high APACHE II score, uremia, liver cirrhosis, and not in the process of being weaned—were associated with high mortality in patients who underwent UE.

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“…Çalışmamızda ileri yaşın ve yüksek APACHE II skorunun yeniden entübasyon için risk faktörü olduğu bulunmuştur. Altmış beş yaş üzerindeki olgularda yeniden entübasyon riski, hastanede yatış süresi ve mortalite anlamlı derecede yüksek bildirilmiştir (4,23,24). Çalışmamızda yeniden entübe edilmeyen gruptaki bir olgu haricinde tüm olgulara NIV uygulandı.…”

Section: Discussionunclassified

Risk Factors for Reintubation and Effects of Reintubation on Outcomes of Intensive Care Patients with Unplanned Extubation

Ediboğlu¹,

Çimen²,

Anar³

et al. 2017

Yoğun Bakim Derg

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Objective: When unplanned extubation (UE) occurs in intensive care patients, mechanical ventilation is negatively affected. In this study, we aimed to investigate the characteristics of UE patients, the duration of extubation, and the characteristics of reintubated patients. Material and Methods:In this retrospective cohort study of UE patients between May 1, 2010 and December 31, 2012, reintubated patients were included in Group 1 (n=12) and patients who did not require reintubation were included in Group 2 (n=12). The demographic features, mechanical ventilation mode, UE cause (patient/staff), APACHE II score, presence of ventilator-associated pneumonia, extubation time, sedation requirement, NIV requirement after extubation, and need of reintubation were recorded. Patients in groups 1 and 2 were compared in terms of risk factors for reintubation.Results: Twenty-four patients (23 males) were included. Their median age was 75 years (range, 56-81 years) [Group 1=79 years (range,[74][75][76][77][78][79][80][81] and Group 2=62 years (range, 56-76 years)]. The APACHE II score was significantly higher in Group 1 patients than in Group 2 patients (27 vs. 23, p=0.03). The pH was significantly lower in Group 1 (7.26 vs. 7.35, p=0.008). Weaning was significantly lower and mortality was significantly higher in Group 1 patients than in Group 2 patients (1/12 vs. 8/12, p=0.003 and 11/12 vs. 1/12, p=0.0001, respectively). The number of patients with ventilator-associated pneumonia was higher in Group 1 than in Group 2 (7/12 vs 2/12, p = 0.035). NIV was applied to all patients except one. Amaç: Yoğun bakım hastalarında plansız ekstübasyon (PE) gerçekleştiğinde mekanik ventilasyon tedavisi aksamakta ve süreci olumsuz etkilemektedir. Bu çalışmada PE gerçekleşen hastaların özellikleri, ekstübasyon süreleri ve yeniden entübe edilen hastaların özelliklerini araştırmayı amaçladık. ConclusionGereç ve Yöntemler: 1 Mayıs 2010 -31 Aralık 2012 tarihleri arasında yoğun bakım ünitemizde PE gerçekleşen 24 hastanın incelendiği retrospektif, kohort çalışmada; yeniden entübe edilen olgular Grup 1 (n=12) ve entübasyon gerekmeyen olgular Grup 2 (n=12) olarak belirlendi. Demografik özellikleri, mekanik ventilatör modu, PE kaynağı (hasta -personel), APACHE II (Acute Physiology and Chronic Health Evaluation) skoru, ventilatör ilişkili pnömoni (VIP) varlığı, ekstübasyon zamanı (mesai içi veya dışı), sedasyon uygulaması, ekstübasyon sonrası noninvazif mekanik ventilasyon (NIV) gereksinimi ve yeniden entübasyon gereksinimi kaydedildi. Yeniden entübasyon için gereken risk faktörleri açısından Grup 1 ve 2 karşılaştırıldı. Bulgular: Yirmi dört hasta (23 erkek) hasta çalışmaya alındı. p=0.044] idi. Grup 1'de APACHE II skoru Grup 2'ye göre anlamlı derecede yüksek (27 vs 23, p=0,03); pH değeri Grup 1'de (7,26 vs 7,35, p=0,008) anlamlı derecede düşük idi. Grup 1'de weaning anlamlı derecede düşük (1/12 vs 8/12, p=0,003) ve mortalite anlamlı oranda yüksek (11/12 vs 1/12, p=0,0001) izlenirken; Grup 1'de VIP tanısı olan hasta sayısı daha fazla idi (7/12 ...

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Age is an Important Predictor of Failed Unplanned Extubation

Cited by 18 publications

References 23 publications

Unplanned Extubation in Patients with Mechanical Ventilation: Experience in the Medical Intensive Care Unit of a Single Tertiary Hospital

Unplanned Extubation in Patients with Mechanical Ventilation: Experience in the Medical Intensive Care Unit of a Single Tertiary Hospital

Prognostic factors and outcomes of unplanned extubation

Risk Factors for Reintubation and Effects of Reintubation on Outcomes of Intensive Care Patients with Unplanned Extubation

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