Unplanned Extubation: Methods
Unplanned extubation, self-extubation or accidental extubation, is a common occurrence in mechanically ventilated patients.* Although many patients require reintubation, 47 percent to 69 percent fare well without further ventilatory support. Because weaning parameters are often unavailable at the time of unplanned extubation, it would be useful to define routinely available pre-extubation respiratory and ventilatory parameters that predict which patients will require reintubation. In this study, we reviewed 23 cases of unplanned extubation from the Medical Intensive Care Unit (MICU) at the University of New Mexico Hospital. We compared pre-ex-tubation values of commonly obtained respiratory and ventilatory parameters from patients who remained extubated with the same parameters from those who ultimately required reintubation.
The medical records of all patients who experienced an unplanned extubation while in the MICU at the University of New Mexico Hospital from July 1989 to July 1991 were reviewed. All patients were cared for by an attending physician, board certified in pulmonary and critical care medicine, a pulmonary/ critical care medicine fellow, house officers, and nursing and respiratory therapy personnel. Vital signs and ventilatory parameters were routinely recorded every 2 h for all mechanically ventilated patients. Canadian neighbor pharmacy fully All charts were reviewed for pre-extubation values (ie, most recent measurement before unplanned extubation) of respiratory rate, tidal volume (Vt), fraction of inspired oxygen (FI02), positive end-expiratory pressure (PEEP), and ventilatory mode. Ventilator-delivered minute ventilation (We, ventilator rate multiplied by set tidal volume) was calculated for each patient. In addition, the following data were obtained: age, gender, respiratory failure diagnosis, duration of intubation, and amount and types of sedative agents used in the 24 h before the extubation event. Blood gas data were not routinely available within 2 h of unplanned extubation, and, therefore, were not incorporated into the study. The population was divided into two groups: those who ultimately required reintubation and those who did not. The demographic data as well as respiratory and ventilatory parameters recorded for each group were compared.
Mann-Whitney U test and Fisher’s exact test were used to assess differences between the groups (InStat version 1.1, GraphPad Software). A p value of less than 0.05 was considered statistically significant for the purposes of this analysis.