Airway accidents in critical care unit: A 3-year retrospective study in a Public Teaching Hospital of Eastern India

Abstract

Background:Although tracheal tubes are essential devices to control and protect airway in a critical care unit (CCU), they are not free from complications.Aims:To document the incidence and nature of airway accidents in the CCU of a government teaching hospital in Eastern India.Methods:Retrospective analysis of all airway accidents in a 5-bedded (medical and surgical) CCU. The number, types, timing, and severity of airway accidents were analyzed.Results:The total accident rate was 19 in 233 intubated and/or tracheostomized patients over 1657 tube days (TDs) during 3 years. Fourteen occurred in 232 endotracheally intubated patients over 1075 endotracheal tube (ETT) days, and five occurred in 44 tracheostomized patients over 580 tracheostomy TDs. Fifteen accidents were due to blocked tubes. Rest four were unplanned extubations (UEs), all being accidental extubations. All blockages occurred during night shifts and all UEs during day shifts. Five accidents were mild, the rest moderate. No major accident led to cardiorespiratory arrest or death. All blockages occurred after 7th day of intubation. The outcome of accidents were more favorable in tracheostomy group compared to ETT group (P = 0.001).Conclusions:The prevalence of airway accidents was 8.2 accidents per 100 patients. Blockages were the most common accidents followed by UEs. Ten out of the 15 blockages and all 4 UEs were in endotracheally intubated patients. Tracheostomized patients had 5 blockages and no UEs.

A retrospective analysis of the incidence and determinants of self-extubation in a tertiary care surgical intensive care unit

“…Self-extubation refers to a removal of endotracheal tube by the patient deliberately. Its incidence differs from 4% to 14%, 2,3,4 and is responsible for almost 68% to 95% of all unplanned extubations. 10 Because of the diversity in the studied ICU population, 5 and differences in the data collection and calculation method, it is difficult to ascertain the precise range of incidence.…”

“…1 The incidence of self-extubation varies from 4% to 14%. 2,3,4 Self-extubation can compromise the patient's health and complicates the safe and gradual process of mechanical ventilation weaning. 5 The most common consequence of self-extubation is the need to reintubate within an hour in 85% to 90% of the cases.…”

Magnitude and associated factors of unplanned extubation in intensive care unit: A multi-center prospective observational study

“…Maintaining endotracheal intubation is the first and most priority important factor in mechanically ventilated patients to save their lives and maintaining ventilation through the artificial airway in intensive care [ 2 ]. These airway management-related complications end up with life-threatening conditions like hypoventilation and hypoxia [ 3 ]. Unplanned extubation is the premature removal of ETT accidently during medical care or by the action of the patient [ 4 ].…”