Analysis of Unplanned Extubation Risk Factors in Intensive Care Units

Abstract

Background: Unplanned extubation (UEX) has potential risk for critical patients. Information on risk factors for UEX is limited. This study identified factors associated with UEX. Methods: All critically ill patients admitted between January 1st, 2007, and December 31st, 2008, to the adult surgical and medical intensive care units who had UEX were included in this retrospective study. Patient risk factors and outcomes were retrospectively reviewed from the medical records and compared with those from control patients matched for age, gender and type of intensive care unit (ICU). Analyzed factors included severity of illness, Glasgow Coma Scale (GCS) before intubation, GCS before UEX or weaning and length of mechanical ventilation (MV) support in the ICU. The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) was used to classify the severity of disease. Results: Three hundred and seventy-eight patients were enrolled. There were 126 patients with unplanned and 252 with planned extubations. Of those with UEX, 45.2% needed re-intubation. Student's t test and multivariate logistic regression were used for each recorded variable. The APACHE II score (p＜0.001), length of MV support (p=0.029), GCS before intubation (p=0.034) and GCS before UEX or weaning (p＜0.001) were predictive of UEX. Discussion: In this study, the APACHE Ⅱ score, length of MV in the ICU, GCS before intubation, and GCS before UEX or weaning can be developed as risk assessment tools. Reevaluation of the aforementioned factors will alert the physicians to ICU patients at risk of UEX and possibly decrease the number of UEX.