One-year Experience with Unplanned Extubation in Adult Intensive Care Units

Abstract

Introduction: Unplanned extubation (UE) is a frequent complication following endotracheal intubation, and can increase intensive care unit (ICU) and hospital expenditure. We attempted to investigate the incidence, outcome and predictive factors of patients who failed UE (reintubation within 48 hours) in the adult ICUs of a medical center in Taiwan. Methods: We reviewed the medical records of patients who experienced UE in intensive care units from July 1, 2004 to June 30, 2005. There were 102 intensive care beds and a total of 3639 admissions with mechanical ventilation via endotracheal tube or tracheostomy. The primary endpoint was factors predicting failed UE, and the second goal was the outcome of failed UE compared with successful UE. Results: One hundred and fifty-two episodes of UE occurred during the study period, representing 4.2% of mechanically ventilated patients. There were 73 episodes of failed UE (48.0%) and 24 patients (15.8%) died during hospitalization. Using multivariate analyses, the 3 risk factors of Glasgow Coma Scales (GCS) scores ＜10, pulmonary causes of intubation, and accidental extubation significantly predicted failed UE. The outcomes of the failed UE patients included: longer stays in the ICU and hospital, and higher hospital costs and mortality. Conclusion: Patients with failed UE suffered a poor prognosis, and increased hospital expenses, and mortality. The predictors of failed UE included GCS＜10, pulmonary causes of intubation and accidental extubation. To provide safe patient care, the physicians should consider the risk factors of failed UE and its potential association with adverse events.