Patient-initiated device removal in intensive care units: A national prevalence study*

Mion, Lorraine C.; Minnick, Ann F.; Leipzig, Rosanne M.; Catrambone, Cathy; Johnson, Mary E.

doi:10.1097/01.ccm.0000291651.12767.52

Cited by 71 publications

(76 citation statements)

References 36 publications

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“…Our rate of unplanned extubation (15%) was consistent with rates reported in the literature, which range from 7% to 18%. 1,[3][4][5][6] The percentage of patients in our study who required reintubation (10.3%), however, was low; researchers in other studies [1][2][3][4][5][6][7]11,14,15,28 have reported reintubation rates of 31% to 78%. This finding, in conjunction with the fact that those patients in our study who experienced unplanned extubation had significantly shorter stays in the MICU and fewer ventilator days suggests that most patients who had unplanned extubation were essentially ready to be extubated.…”

Section: Discussionmentioning

confidence: 65%

“…Agitation and lack of sufficient sedation have repeatedly been identified as factors contributing to unplanned extubation. 3,4,14,15 To address agitation and standardize sedation management practices among patients receiving mechanical ventilation, many institutions have adopted protocols or guidelines for administration of pain and sedation medications. Implementation of these protocols has decreased the variability of the types of medications used, shortened the duration of mechanical ventilation, and decreased length extubation were prospectively collected on all patients consecutively admitted to the MICU who required mechanical ventilation.…”

Section: Designmentioning

confidence: 99%

“…1,[3][4][5][6] Risks associated with unplanned extubation include bronchospasms, arrhythmias, aspiration, pneumonia, respiratory failure, and cardiopulmonary arrest. 7,8 Although mortality rates have not consistently been shown to increase with unplanned extubation, unplanned extubation does result in prolonged mechanical ventilation, longer ICU and hospital stay, and an increased need for chronic care for those patients who do not tolerate an unplanned extubation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Role of Standardized Protocols in Unplanned Extubations in a Medical Intensive Care Unit

Jarachovic

Mason

Kerber

et al. 2011

American Journal of Critical Care

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Background Many patients admitted to medical intensive care units require mechanical ventilation to assist with respiratory management. Unplanned extubations of these patients are associated with poor outcomes for patients and organizations. No previous research has investigated the role of standardized protocols in unplanned extubations when examined in conjunction with traditional risk factors. Objective To identify risk factors associated with unplanned extubation among patients receiving mechanical ventilation and determine degree of compliance with pain, sedation, and weaning protocols. Methods A prospective cohort study design was used. Data on all patients admitted to the medical intensive care unit who required mechanical ventilation were gathered daily. Additional data were gathered on those patients who experienced unplanned extubation. Descriptive, correlational, and regression analyses were performed. Results Weaning protocols were a significant predictor of unplanned extubation: patients who had weaning protocols ordered and followed were least likely to experience unplanned extubation. Only 10% of the 190 patients in the study required reintubation, resulting in a significantly shorter ventilation time and unit length of stay among the unplanned extubation group. Conclusions Weaning protocols were associated with decreased incidence of unplanned extubation. Use of standardized protocols was feasible, as compliance among health care providers was high when protocols were medically prescribed. The reintubation rate in this study was low and associated with a significantly shorter ventilatory period and unit length of stay in the unplanned extubation group. (American Journal of Critical Care. 2011;20:304- Within our institution, an ongoing quality improvement project indicated that unplanned extubation continued to occur despite implementation of sedation, pain management, and weaning protocols that addressed factors reported in the literature to be associated with unplanned extubation. Additional investigation was needed to explore factors associated with unplanned extubation. Therefore, a research project was initiated with the following study aims: (1) to identify factors associated with unplanned extubation among patients admitted to the MICU who are receiving mechanical ventilation and (2) to determine the degree of compliance of physicians and nurses with sedation, pain, and weaning protocols.

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Section: Discussionmentioning

confidence: 65%

Section: Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Role of Standardized Protocols in Unplanned Extubations in a Medical Intensive Care Unit

Jarachovic

Mason

Kerber

et al. 2011

American Journal of Critical Care

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“…This study provide support that continuous assessment of sedation by Sedline monitor was associated with a decrease in the incidence of oversedation as was seen in S group. Decreasing sedative use in S group appeared safe and was not complicated by any increase in undersedation events as any self-device removal event, or ventilatory asynchrony [15]. All measured emergence times in this study (defined as verbal command responses (eye opening, hand squeezing) tracheal extubation, and orientation (defined as providing correct date of birth)…”

Section: Discussionmentioning

confidence: 99%

SEDLine Monitored Sedation and Recovery for Postoperative Ventilated Recipients of Living Donor Liver Transplantation: A Randomized Controlled Trial

EK¹

2015

J Anesthe Clinic Res

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“…Plansız ekstübasyon (PE), endotrakeal entübasyon uygulanan kritik hastalarda görülebilen, morbidite ve mortalitesi yüksek bir durumdur (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Yoğun bakımın ve izlenen hastaların özelliklerine ve mekanik ventilasyon süresine göre insidans değişmektedir (%0,3-16) (7,13,14).…”

Section: Introductionunclassified

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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Patient-initiated device removal in intensive care units: A national prevalence study*

Abstract: Device removal by ICU patients is common, resulting in harm in one fourth of patients and significant resource expenditure. Further examination of patient-, unit-, and practitioner-level variables may help explain variation in rates and provide direction for further targeted interventions.

Cited by 71 publications

References 36 publications

The Role of Standardized Protocols in Unplanned Extubations in a Medical Intensive Care Unit

The Role of Standardized Protocols in Unplanned Extubations in a Medical Intensive Care Unit

SEDLine Monitored Sedation and Recovery for Postoperative Ventilated Recipients of Living Donor Liver Transplantation: A Randomized Controlled Trial

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

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