Assessing the Need for Reintubation: A Prospective Evaluation of Unplanned Endotracheal Extubation

Abstract

A total of 85% of patients who self-extubate during the weaning process did not require reintubation in our study. Those who have an FiO2 >50%, a lower PaO2/FiO2 ratio, had UEE occur by accident, or were not being weaned when UEE occurred required reintubation more frequently. These data suggest that some of our SICU patients are intubated longer than necessary, which may translate into more ventilator related complications, longer ICU stays and increased cost.

Unplanned extubation in pediatric critically ill patients: A systematic review and best practice recommendations*

“…These patients experienced a low risk for reintubation, akin to the published reports in adult weaning UE patients (15%-30%) (19,22,47,48). Such UE may indicate a delay in weaning and extubation by nursing or medical staff, rather than insufficient management of agitation and patient comfort.…”

Predicting extubation failure in blunt trauma patients with pulmonary contusion

“…P/F ratio seems to be helpful in ventilator weaning, but the reported threshold values vary from 150 to 300. 2,6,9,18 In our institution, P/F ratio of 200 or greater is used as one of the weaning criteria by respiratory therapists for evaluation of readiness to wean intubated ICU patients. Our respiratory therapists use a checklist when assessing mechanically ventilated trauma patients for spontaneous breathing trial before extubation: evidence of sedative reversal, P/F of 200 or greater, positive end-expiratory pressure of 5 or less, FIO 2 less than 0.5, pH greater than 7.25, hemodynamic stability, use of vasopressors, and inspiratory effort.…”

Ações de enfermagem para a prevenção da extubação acidental

“…Antes da implementação do guia a taxa foi de 8,33% extubações acidentais ocasionadas pela equipe de enfermagem reduzindo para 2,85% eventos.Em relação às taxas de extubações acidentais encontradas, na revisão feita por Yeh et al (1) , estudos de 1994 a 2002 indicam que a incidência de extubação não planejada varia de 3% a 14% (4,(6)(7)(8)(9)(10)(11)(12) . Destes casos de extubação não planejada, 77.9 a 87% foram auto-extubações e 13 a 22,1% foram acidentais (7,8) .…”