Airway accidents in an intensive care unit

Abstract

Aim: To document the incidence of airway accidents in the Intensive Care Unit, and to identify the difference in accident rates between short term and long term intubated patients, and between endotracheal intubation and tracheostomy. Design: Prospective, observational non-interventional study. Patients and Methods: All adult patients with either an endotracheal tube or tracheostomy were divided into two groups: intubation for 24 hours, {Long-term intubation/ LTI}. The number of tube days (TDs) were calculated from the day of intubation till the day of extubation, discharge or death. The following airway accidents were noted: blocked tube (BT), unplanned extubations (UE), endobronchial intubation (EBI), kinked tube and leaking cuff. Results: 781 patients (1440 tube days) were studied. 665 patients (951 tube days) required an endotracheal tube. 116 patients (489 tube days) had a tracheostomy. 697 patients (697 tube days) required STI while 84 patients (743 tube days) required LTI. Overall there were 55 airway accidents with an incidence of 7.04% of patients and 3.82 / 100 tube days. The airway accident rate was 4.02 / 100 TD’s and 3.63/ 100 TD’s for STI and LTI, respectively, and 4.21 / 100 TD’s and 3.07 /100 TD’s for endotracheal intuibation and tracheostomy, respectively. Blocked tubes (2.15 per 100 TD’s) and Unplanned extubations (1.32 per 100 TD’s) were the most common airway accidents. Conclusion: The overall incidence of airway accidents was 3.82/ 100 TD’s and 7.04% of patients with no significant difference between STI vs. LTI and endotracheal tube vs. tracheostomy. Control of the airway with the help of a tracheal tube is an important aspect of intensive care. The use of tracheal tubes however is not without complications. The longer a tube stays in-situ, the greater the chances of kinking, blockade and unplanned extubations. All of the above can lead to hypoventilation and hypoxia which are potentially life threatening. The few studies on unplanned extubations have reported an incidence ranging from 0.3 - 30% .1-2 Significant proportions of those who have an unplanned extubation tolerate it well and do not require reintubation. 6,8 Most of these are associated with minimal or no morbidity. 4 One study of 53 patients however