oa Southern African Journal of Anaesthesia and Analgesia - Unplanned extubations in an academic intensive care unit : research
<I>Objective:</I> To describe the incidence, risk factors and outcome of unplanned extubations (UEXs) in our intensive care unit. <br><I>Design:</I> A prospective, observational study. <br><I>Setting:</I> Intensive care unit (ICU) of the Dr. George Mukhari Hospital, which is a teaching hospital. <br><I>Patients:</I> All patients who experienced an episode of unplanned extubation ( self-extubation by the patient or accidental extubation by members of staff during bedside procedures) during the period June 2001 to December 2001. <br><I>Interventions:</I> None. <br><I>Measurements and Main Results:</I> The main variables studied were the occurrence rate of UEX, the risk factors for the event, the re-intubation rate and the mortality rate. A total of 233 patients received ventilatory support with an endotracheal tube during the study period. Twenty-four patients (10.3%) experienced an unplanned extubation. Six of these patients (25%) required re-intubation for respiratory failure (defined as failure to achieve an oxygen saturation of <u>></u> 90% or Pa0<sub>2</sub> of <u>></u> 8KPA, despite maximum oxygen supplementation via face mask and/ or tachypnoea of > 35 breaths/min). One death occurred as a direct consequence of the event. Patients who required re-intubation had a significantly higher mean FIO<sub>2</sub> just prior to the UEX compared to those who did not require re-intubation (0.64 <u>+</u> 0.18 vs. 0.43 <u>+</u> 0.08; p=0.031).The mean set breath rate just before the UEX was also significantly different between the two groups of patients (13.16 <u>+</u> 3.49 vs. 8.88 <u>+</u> 4.51; p=0.046). A comparison of the mean values of PEEP, PH, PaO<sub>2</sub>, PaC0<sub>2</sub> and HCO<sub>3</sub> just before the UEX revealed no statistically significant differences between the patients that required re-intubation and those that did not. Oral intubation, lack of sedation and lack of restraints were confirmed to be risk factors for UEXs. <br><I>Conclusion:</I> The study suggests that the more respiratory support ( as evidenced by a high set breath rate and a high FI02 ) the patient requires at the time of the UEX, the more likely they are to require re-intubation. Although the incidence, the re-intubation rate and the predisposing factors for UEXs in the unit are similar to those reported in the literature, the study suggests that the unit needs to pay special attention to some of the measures known to be capable of minimizing the incidence of this potentially lethal complication of mechanical ventilation. In particular, the use of sedation and the care of the endotracheal tube during bed-side procedures are important issues.
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