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

Abstract

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.

Prognostic factors and outcomes of unplanned extubation

“…We found that 136 (46.1%) patients required reintubation within 48 hours after UE, and that the mortality rate of UE patients who required reintubation was higher than for patients who did not: 25.0% (34/136) vs. 6.9% (11/159). This is consistent with previous studies 14 , 20 , 26 . Overall, reintubation was associated with poorer outcomes in UE patients.…”

Case-control Study on Risk Factors of Unplanned Extubation Based on Patient Safety Model in Critically Ill Patients with Mechanical Ventilation

“…According to a previous study, nurse-driven sedation protocol is helpful in preventing adverse events [14]. Thus, the results of higher motor response scores and more likelihood of emergency admissions in the unplanned extubation group suggest that a sedation protocol is necessary and admission to the emergency group requires closer observation.…”

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

“…Endotrakeal entübasyon sonrasında gelişebilecek önemli bir komplikasyon olan PE, hastanın ventilatörden ayrılmasına ve hava yolu kontrolünü kaybetmesine yol açan bir durumdur (17). Weaning planlanmadan ekstübe olan hastaların oranı pek çok çalışmada %0,3 -16 arasında olarak bildirilmiştir (7,13,14,18). Bizim çalışmamızda PE oranı %6,7 idi.…”