Outcomes of unplanned extubation in ordinary ward are similar to those in intensive care unit

Abstract

Unplanned extubation (UE) may cause considerable adverse effects in patients receiving mechanical ventilation (MV). Previous literature showed inconsistent prognosis in patients with UE. This study aimed to evaluate the clinical implications and outcomes of UE.The intubated adult patients with MV support in our hospital were enrolled, and they were divided into the UE and non-UE groups. Demographic data, admission unit, MV duration, overall weaning rate, and mortality rates were compared. The outcomes of UE in ordinary ward and intensive care unit (ICU) were also assessed.Totally 9245 intubated adult patients were included. UE occurred in 303 (3.5%) patients, and the UE events were 0.27 times/100 MV days. Old age, nonoperation related MV cause, and admission out of the ICU were significant factors associated with UE events. UE patients showed a trend of better overall weaning rate (71.9% vs 66.7%, P = .054) than non-UE. However, the in-hospital mortality rate (25.7% vs 24.8%, P = .713) were similar between the UE and non-UE patients. The reintubation rate of UE patients was 44.1% (142/322). Successful UEs were associated with patients in weaning process (52.8% vs 38.7%, P = .012), and patients received non-invasive positive pressure ventilation (NIPPV) support after UE (19.4% vs 3.5%, P < .001). Patients with successful UE had significantly shorter MV days, higher overall weaning rate, and lower mortality than those with unsuccessful UE. Outcomes of UE in ordinary ward and in ICU had similar MV duration, reintubation rate, overall weaning rate, and in-hospital mortality rate.The overall weaning rate and in-hospital mortality rates of the UE and non-UE patients were similar. UE occurred in ordinary ward had similar outcomes to those in ICU. Patients receiving MV should be assessed daily for weaning indications to reduce delayed extubation, and therefore, may decrease UE occurrence. Once the UE happened, NIPPV support may reduce the reintubation rate.

Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study

“…Reintubation is required for various reasons [ 3 ]. Lin P H and colleagues reported that reintubation cases due to accidental removal or self-removal of the tracheal tube both had distinct risk factors and prognoses [ 8 ]. In this study, we classified the unplanned reintubation cases by cause, excluded the non-respiratory cases, and mainly focused on AAC-caused reintubation after general anesthesia since the postoperative respiratory compromise cases stood out as the majority (36/48, 75.0%).…”

Prognostic nomogram for elderly patients with acute respiratory failure receiving invasive mechanical ventilation: a nationwide population-based cohort study in Taiwan

“…In fact, literature has shown that elderly critical patients had a greater rejection rate (18–36%) for ICU admission, when compared to the rejection rate (11–15%) of those aged < 65 years 25 . In some areas, a significant percentage (7.6–38.4%) of critical patients with IMV even had to stay in the general ward owing to shortage of ICU beds, and the condition was more severe for elderly patients (up to 51.1%) 7 , 26 , 27 . In the near future, many hospitals will be facing similar problems, when the increasing number of elderly patients with IMV exceeds the reserve of critical care manpower and resources.…”

Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study

“…Reintubation is required for various reasons [3] . Lin P H and colleagues reported that reintubation cases due to accidental removal or self-removal of the tracheal tube both had distinct risk factors and prognoses [8] . In this study, we classi ed the unplanned reintubation cases by cause, excluded the nonrespiratory cases, and mainly focused on AAC-caused reintubation after general anesthesia since the postoperative respiratory compromise cases stood out as the majority (36/48, 75.0%).…”