Clinical Features and Outcomes of Patients with Unplanned Endotracheal Extubation in a Mixed Intensive Care Unit

加護病房中非計劃性氣管内管拔管的臨床特徵舆预後

張祐綸(You-Lung Chang) ； 簡榮彥(Jung-Yien Chien) ； 古世基(Shih-Chi Ku) ； 余忠仁(Chong-Jen Yu) ； 楊泮池(Pan-Chyr Yang)

《胸腔醫學》 22卷6期 (2007/12) Pp. 378-386

https://doi.org/10.29806/TM.200712.0001

摘要

Objectives: To describe the clinical features of patients with unplanned endotracheal extubation (UEE) and their outcomes after the event.
Design: A retrospective study from February 2003 to August 2005.
Setting: A 23-bed mixed intensive care unit in a branch of a university hospital.
Patients: All adult patients undergoing endotracheal intubation in a mixed intensive care unit (ICU) who experienced a UEE event.
Measurments and Main results: During the 31-month period, a total of 2655 patients were admitted to the ICU. After counting the first episode in the same ICU admission, there were 41 episodes (2.56%) of UEE among 1601 patients. There was male gender predominance among the patients. Thirty-six out of 41 patients had deliberate self-extubation, while the other 5 experienced an accidental extubation. There seemed to be a trend toward a higher rate of UEE during the nursing shift change, and secular trends in the month of May. At the moment of UEE, 25 patients (61%) were in a full ventilatory support status, and 16 (39%) were undergoing weaning from mechanical ventilation; 18 and 7 patients, respectively, were reintubated after the UEE episode. Those who needed reintubation had a higher FiO2 demand (p＜0.05) and a higher pH value of arterial blood gas (p＜0.05) than those did not. UEE patients with reintubation had a longer ICU stay. Hospital mortality was around 20% among these patients; however, those with reintubation had a higher mortality than those without (32 vs. 6.3%).
Conclusion: Reintubation in patients with UEE indicates a poorer clinical outcome. Risk factors associated with reintubation after the UEE episode include a high pH value of arterial blood gas and a high O2 demand. These results remind us to put more effort into clinical practice to prevent UEE events and improve care after the UEE event in the acute care setting.

關鍵字

非計劃性氣管内管拔管 ； 故意自拔管 ； 意外拔管

並列摘要

Objectives: To describe the clinical features of patients with unplanned endotracheal extubation (UEE) and their outcomes after the event.
Design: A retrospective study from February 2003 to August 2005.
Setting: A 23-bed mixed intensive care unit in a branch of a university hospital.
Patients: All adult patients undergoing endotracheal intubation in a mixed intensive care unit (ICU) who experienced a UEE event.
Measurments and Main results: During the 31-month period, a total of 2655 patients were admitted to the ICU. After counting the first episode in the same ICU admission, there were 41 episodes (2.56%) of UEE among 1601 patients. There was male gender predominance among the patients. Thirty-six out of 41 patients had deliberate self-extubation, while the other 5 experienced an accidental extubation. There seemed to be a trend toward a higher rate of UEE during the nursing shift change, and secular trends in the month of May. At the moment of UEE, 25 patients (61%) were in a full ventilatory support status, and 16 (39%) were undergoing weaning from mechanical ventilation; 18 and 7 patients, respectively, were reintubated after the UEE episode. Those who needed reintubation had a higher FiO2 demand (p＜0.05) and a higher pH value of arterial blood gas (p＜0.05) than those did not. UEE patients with reintubation had a longer ICU stay. Hospital mortality was around 20% among these patients; however, those with reintubation had a higher mortality than those without (32 vs. 6.3%).
Conclusion: Reintubation in patients with UEE indicates a poorer clinical outcome. Risk factors associated with reintubation after the UEE episode include a high pH value of arterial blood gas and a high O2 demand. These results remind us to put more effort into clinical practice to prevent UEE events and improve care after the UEE event in the acute care setting.

並列關鍵字

unplanned endotracheal extubation ； deliberate self extubation ； accidental extubation