Unplanned extubation in the intensive care unit: what are the consequences?
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KeywordsEndotracheal Tube Pressure Support Occurrence Rate Ventilator Setting Ventilatory Mode
Unplanned extubation occurs in approximately 1–14% of patients receiving mechanical ventilation. These extubations have widely varying effects on morbidity and mortality. Patients who experience an unplanned extubation in the ICU may experience a survival benefit, provided that they do not require reintubation. Our objective was to document the incidence of unplanned extubations, to discern possible variables predictive of occurrence and outcome, and to formulate preventive measures. These data were compared with the medical literature.
A retrospective study of all adult patients intubated in a 10-bed mixed (clinical and surgical) ICU for a 24-month period. The unplanned extubations rate was analyzed. Patients admitted with previous tracheostomy were excluded. Variables examined included the ventilator settings before self-extubation, use of sedatives, the RAMSAY scale, duration of intubation, arterial blood gases after self-extubation and Acute Physiology and Chronic Health Enquiry II (APACHE II) scores.
Of 203 adults intubated in the 24-month period, four (2%) unplanned extubations occurred. Only one was reintubated, and a few hours later the endotracheal tube was removed safely. Three patients were male. Two patients were admitted for trauma. The mean APACHE II score was 17.75 ± 10.47. The patients studied have a RAMSAY scale of 3 (two patients) or 2 (two patients). Unplanned extubation patients were ventilated for 4 ± 0.5 days (range, 4–5 days) before their episode of unplanned extubation. Pressure support (PSV) was the main ventilatory mode in this group. All patients received sedation propofol (two patients) or dexmetedomidine (two patients) during the self-extubation day. All patients were discharged from the ICU.
Our data suggest that self-extubation is relatively rare in our institution compared with the literature. Trauma patients and the presence of pain should alarm the ICU team for this complication. Staff vigilance and a proper weaning period were some of the factors to which we attributed this low occurrence rate.