The Drive to Survive

Krinsley, James S.; Barone, James E.

doi:10.1378/chest.128.2.560

Cited by 68 publications

(47 citation statements)

References 12 publications

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“…UEs account for approximately 10% (range, 3% to 16%) of extubations and require reintubation in 60% of the cases [4]. Furthermore, experiencing an UE is associated with prolonged duration of mechanical ventilation, ICU stay and hospital stay compared to not having experienced an UE [4,15,16]. Reported risk factors for UE include route of tracheal intubation, method of tube fixation [3] and method and level of sedation [3,17].…”

Section: Introductionmentioning

confidence: 99%

Risk factors and outcome after unplanned extubations on the ICU, a case-control study

et al. 2011

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IntroductionUnplanned extubation (UE) is a frequent event during mechanical ventilation in critically ill patients and might be associated with increased morbidity and mortality. However, detailed knowledge of risk factors and outcomes after UE is lacking.MethodsA case-control study was performed with a case to control ratio of 1:4. Incidence density sampling was applied. Seventy-four cases and 296 control patients were included.ResultsSeventy-four UEs occurred in 69 patients, comprising 2% of all mechanically ventilated patients. Multivariable regression analysis revealed that the first and second categories of the Ramsay Sedation Scale score were associated with a high risk for an UE (odds ratios (ORs) 30 and 25, respectively). Male sex, subunit of the intensive care unit (ICU), length of stay in the ICU and midazolam use at time of UE were also risk factors for an UE. Patients with an UE had lower hospital mortality than mechanically ventilated patients without UE, 10% versus 30%, respectively. Forty-seven percent (n = 35) of the patients with an UE had to be reintubated.ConclusionsThe present study shows that the first and second categories of the Ramsay Sedation Scale were associated with a high risk for an UE. Also, male sex and use of midazolam at time of UE were identified as risk factors for an UE. However, compared with mechanically ventilated controls, no increased mortality was shown for UE patients. In UE patients without the need for subsequent reintubation, mortality was very low.

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Section: Introductionmentioning

confidence: 99%

Risk factors and outcome after unplanned extubations on the ICU, a case-control study

et al. 2011

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“…Other authors [4,5] have reported a lower frequency of unplanned extubation in comparison with previous studies.…”

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confidence: 47%

Unplanned extubation in the ICU: a marker of quality assurance of mechanical ventilation

2011

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One of the most frequent complications associated with endotracheal intubation itself in intensive care units is unplanned extubation, which represents a potentially serious complication given that many patients may need reintubation while in poor condition. This scenario may account for an increase in morbidity and even in mortality. To be able to compare the rates of unplanned extubation in clinical practice, unplanned extubation should be expressed as incidence density of days at risk. Also, this complication (unplanned extubation and reintubation rates) may be used as a marker of quality of weaning care in intensive care units.

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“…There have been several preventive measures to avoid UE in previous reports, [1,19–22] including continuous education of nurses, agitation avoidance, 24-hour bedside surveillance, appropriate nurse to patient ratio, the method for securing the endotracheal tube when adjusting patient positioning, and supervision of patients ready for withdrawal from MV. In this study, we used several interventions during this quality improvement program.…”

Section: Discussionmentioning

confidence: 99%

“…Most important, however, is that a UE results in prolonged use of MV, longer ICU and hospital stays, and an increased need for chronic care, especially for a failed UE. [1,2] …”

Section: Introductionmentioning

confidence: 99%

“…[3–8] Despite these efforts, the reported rates of UE remain between 7% and 18% in most ICUs. [1,9–12] Other studies have identified several risk factors of UE: patient factors such as irritability, an altered level of consciousness, the lack of a sedation protocol, and structural and environmental factors, such as oral intubation, the method of securing the tube, and physical restraints. [12–15] All of the above findings should suggest that although a single intervention might temporarily reduce the UE rate, a comprehensive and sustained program is the only way to solve this complication in the ICU.…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units

Chao

Lai

Chan³

et al. 2017

Medicine

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The Drive to Survive

Cited by 68 publications

References 12 publications

Risk factors and outcome after unplanned extubations on the ICU, a case-control study

Risk factors and outcome after unplanned extubations on the ICU, a case-control study

Unplanned extubation in the ICU: a marker of quality assurance of mechanical ventilation

Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units

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