Unplanned Extubation: Results
During the study period, there were 319 mechanically ventilated patients in the MICU; 23 unplanned extubations occurred during the same period (7 percent of all ventilated patients). Of the 23 events, only 2 appeared to have been accidental extubations, while the remainder were most likely intentional (self-extubations). In all cases, important measures had been taken to prevent unplanned extubation; bilateral wrist restraints were in place at the time of extubation in 21 of the 23 cases. The remaining two patients most likely had wrist restraints, as is protocol in our ICU, but this was not specifically noted in the medical records. In 15 of the 23 cases (65 percent), the patients had received intravenous sedation within 4 h of extubation (Table 1).
Among the 23 unplanned extubations, 17 patients required reintubation, 1 patient on two separate occasions (RI group, 78 percent of unplanned extubations), and 5 did well without further ventilatory support (NRI group) Click Here canadian family pharmacy. There was no significant difference in age, gender distribution, or duration of intubation between the two groups (Tables 1 and 2).
In all cases, the decision to reintubate was made by a physician in attendance, and was based on clinical indicators of respiratory failure such as rapid shallow breathing and refractory hypoxemia.
The distribution of respiratory failure diagnoses between the two groups was markedly different (Table 1). Of the five patients in the NRI group, three (60 percent) suffered from toxic ingestion as the primary cause of respiratory failure. Only one patient (20 percent) in this group was diagnosed as having pneumonia. By contrast, in only one of the RI patients in the NRI group (1.4 L/min, p=0.007). In 17 of 18 events, a V Ve >0 L/min was associated with the need for reintubation, and all patients receiving a We >7.0 L/min required reintubation (Fig 2). The mean values of PEEP (p=0.229), total minute ventilation (p=0.427), and pre-extubation respiratory rate (p=0.724) did not differ significantly between the two groups. Weaning parameters had been documented before unplanned extubation in only one patient and correctly predicted the need for continued mechanical ventilation.
One patient sustained severe anoxic brain injury as a result of unplanned extubation and ultimately died.
Table 1—Demographics of Reintubated Patients and Those Who Were Not Reintubated
Patient/Age, yr/Gender | Diagnosis* | Duration of Intubation, h | Sedated | Restrained |
Not reintubated | ||||
1/42/M | Isopropyl alcohol ingestion | 8 | No | Yes |
2/19/F | Camphor oil ingestion | 19 | Yes | Yes |
3/80/F | Sepsis | 336 | Yes | Yes |
4/86/M | Pneumonia, COPD | 120 | No | \ |
5/34/M | Alcohol and barbiturate ingestion | 15 | No | Yes |
Reintubated | ||||
6t/52/F | Pneumonia, COPD | 9 | Yes | Yes |
156 | No | Yes | ||
7/43/M | ARDS | 120 | Yes | t |
8/89/M | Pneumonia | 46 | Yes | Yes |
9/46/F | Sepsis | 18 | Yes | Yes |
10/30/F | Guillian-Barre syndrome | 42 | Yes | Yes |
11/78/M | Pneumonia | 4 | Yes | Yes |
12/31/F | Drug overdose, pneumonia | 72 | No | Yes |
13/30/M | Pneumonia, MVA | 25 | Yes | Yes |
14/43/F | Asthma | 109 | No | Yes |
15/60/M | Atypical pneumonia, COPD | 136 | Yes | Yes |
16/69/M | ARDS | 7 | Yes | Yes |
17/62/F | Sepsis | 20 | Yes | Yes |
18/42/M | PCP | 72 | No | Yes |
19/21/M | PCP | 108 | Yes | Yes |
20/32/M | PCP | 3 | Yes | Yes |
21/71/F | Pneumonia | 94 | No | Yes |
22/76/M | Conjestive heart failure | 64 | Yes | Yes |
Table 2—Demographics and Ventilatory Parameters of Reintubated Patients Compared With Those Who Were Not Reintubated
Reintubated, Mean ± SEM | Not Reintubated, Mean ± SEM | p Valuet | |
Ventilator-delivered Ve, L/min | 9.7 ±1.5 | 1.4± 1.4 | 0.007 |
FI02, % | 49.7 ±3.7 | 35.0 ±2.2 | 0.021 |
PEEP, cm H20 | 3.9 ±1.0 | 1.0±1.0 | NS |
Total Ve, L/min | 16.0 ±1.6 | 12.5 ±1.0 | NS |
RR, breaths/min | 23.6 ±2.6 | 23.6 ±3.1 | NS |
Intubation time, h | 61.4 ± 11.7 | 99.6 ±62.6 | NS |
Age, yr | 51.5±4.6 | 52.5 ±13.1 | NS |
Gender, M/F | 10/7 | 3/2 | NS |
Figure 1. Comparison of FI02 values in patients who were reintubated (RI) vs those who were not reintubated (NRI). Closed circles represent the individual data points; open circles, the mean ± SEM of each group.
Figure 2. Comparison of We values in patients who were reintubated (RI) vs those who were not reintubated (NRI). Closed circles represent the individual data point; open circles, the mean ± SEM of each group.