Unplanned endotracheal extubation in the intensive care unit

Abstract

Study Objective: To identify the frequency, outcome, and factors associated with unplanned endotracheal extubation (UE) in the intensive care unit (ICU). Design: Prospective study. Setting: An urban, university trauma-surgical ICU. Patients: 96 intubated ICU patients who underwent 101 episodes of UE. Interventions: Patient, nursing, respiratory, and demographic factors associated with UE and patient outcome were determined for one year. Results were presented to nursing staff. The incidence of UE as a function of the total number of ventilator days was determined for one year post nursing education. Endpoints: Patients with UE were identified. Patients with reintubation were followed until final extubation. Measurements and Main Results: 85% of UE were self-extubations and 15% were accidental. Self-extubations occurred with equal frequency during all three nursing shifts in alert or agitated patients who were not being weaned. Accidental extubations occurred during the day shift in less alert patients and were associated with transport procedures and the use of rotary beds. Overall, 57% of patients were reintubated and most reintubations were in the first hour. Difficulty with reintubation was common, and one patient who could not be reintubated died. There were significantly fewer UE per ventilator day after nursing education. Conclusions: Patients should be observed closely after unplanned extubation, although many may not require reintubation. Reintubation can be quite difficult, necessitating highly shitted airway management. Attention to associated risk factors may decrease the incidence of both accidental and self-extubation.