A prospective study of unplanned endotracheal extubation in intensive care unit patients.

Abstract

To evaluate incidence, factors associated with unplanned endotracheal extubation (UEE), and prognostic factors for reintubation. A prospective study over a 32-mo period. A 16-bed general intensive care unit of a tertiary university hospital. Adult subjects undergoing endotracheal intubation for >48 hrs. Observation of patients who presented unplanned extubation. Over the 32-mo period, there were 59 episodes of UEE in 55 patients (frequency 7.3%). Deliberate self-extubation occurred in 46 episodes (77.9%), while there were 13 episodes (22.1%) of accidental extubation. Twenty-seven (45.8%) episodes occurred in patients who were receiving full mechanical ventilatory support and 32 (54.2%) episodes occurred during the weaning period from mechanical ventilation. Reintubation was required in 27 (45.8%) episodes of UEE. The need for reintubation after UEE was 36.9% in deliberate self-extubation patients and 76.9% in accidental extubation patients (p = .01). Only 15.6% (5/32) of patients who presented UEE during weaning required reintubation, while reintubation was mandatory in 81.5% (22/27) of patients who presented UEE during full mechanical ventilatory support (p < .001). A multiple logistic regression analysis was performed to determine the variables independently associated with the need for reintubation: days of mechanical ventilation were significantly associated with the need for reintubation, and weaning was associated with no need for reintubation. The model correctly classified the need for reintubation in 84.7% (50/59) of cases. Reintubation in UEE patients strongly depends on the type of mechanical ventilatory support. The probability of requiring reintubation if UEE occurs during full ventilatory support is higher than if UEE occurs during weaning. These data suggest that some patients are under mechanical ventilation longer than necessary.