Unplanned extubation in orally intubated medical patients in the intensive care unit: A prospective cohort study

Abstract

Unplanned endotracheal extubation (UE) is recognized as the most common airway adverse event in the intensive care unit (ICU). We examined the incidence, circumstances, and outcome of UE in orally intubated medical patients in the ICU. We performed a 12-month prospective cohort study in a tertiary-care medical ICU. A total of 344 consecutive adults who were orally intubated and mechanically ventilated for 3710 days were included. The overall incidence density of UE was .92 of 100 days of ventilation. Eight episodes (24%) occurred in patients receiving mechanical ventilation (MV) and not in the weaning process versus 26 episodes (76%) in patients scheduled for weaning. UE was reported as intentional in 71% of cases and as accidental in 29% of cases. In 59% of UE cases, patients were without caregivers at the bedside when the episode took place, and 46% of cases occurred during the night shift. Reintubation was required in 41% of patients and was strongly associated with the accidental nature of the episode (odds ratio [95% confidence interval]: 4.3 [1.9-9.6]). Compared with patients without UE, patients with UE had a lower mortality rate (odds ratio [95% confidence interval]: .21 [.6-.8]) but longer days on MV (11.5 vs 5, P = .09) and ICU stay (13.5 vs 6, P = .08). This study does not confirm the highest rates of UE previously reported in orally intubated medical patients in the ICU or the association with mortality in this scenario. However, UE increased the need for MV and ICU care. We found a moderate to high prevalence of potentially modifiable risk factors for UE, suggesting unsatisfactory ICU practices.