Frequency and Analysis of Unplanned Extubation in Coronavirus Disease 2019 Patients

Abstract

Objectives: To determine if patients with coronavirus disease 2019 had a greater number of unplanned extubations resulting in reintubations than in patients without coronavirus disease 2019. Design: Retrospective cohort study comparing the frequency of unplanned extubations resulting in reintubations in a group of coronavirus disease 2019 patients to a historical (noncoronavirus disease 2019) control group. Setting: This study was conducted at Henry Ford Hospital, an academic medical center in Detroit, MI. The historical noncoronavirus disease 2019 patients were treated in the 68 bed medical ICU. The coronavirus disease 2019 patients were treated in the coronavirus disease ICU, which included the 68 medical ICU beds, 18 neuro-ICU beds, 32 surgical ICU beds, and 40 cardiovascular ICU beds, as the medical ICU was expanded to these units at the peak of the pandemic in Detroit, MI. Patients: The coronavirus disease 2019 cohort included patients diagnosed with coronavirus disease 2019 who were intubated for respiratory failure from March 12, 2020, to April 13, 2020. The historic control (noncoronavirus disease 2019) group consisted of patients who were admitted to the medical ICU in the year spanning from November 1, 2018 to October 31, 2019, with a need for mechanical ventilation that was not related to surgery or a neurologic reason. Interventions: None. Measurements and Main Results: To identify how many patients in each cohort had unplanned extubations, an electronic medical records query for patients with two intubations within 30 days was performed, in addition to a review of our institutional quality and safety database of reported self-extubations. Medical charts were manually reviewed by board-certified anesthesiologists to confirm each event was an unplanned extubation followed by a reintubation within 24 hours. There was a significantly greater incidence of unplanned extubations resulting in reintubation events in the coronavirus disease 2019 cohort than in the noncoronavirus disease 2019 cohort (coronavirus disease 2019 cohort: 167 total admissions with 22 events—13.2%; noncoronavirus disease 2019 cohort: 326 total admissions with 14 events—4.3%; p < 0.001). When the rate of unplanned extubations was expressed per 100 intubated days, there was not a significant difference between the groups (0.88 and 0.57, respectively; p = 0.269). Conclusions: Coronavirus disease 2019 patients have a higher incidence of unplanned extubation that requires reintubation than noncoronavirus disease 2019 patients. Further study is necessary to evaluate the variables that contribute to this higher incidence and clinical strategies that can reduce it.

The Clinical Nursing Pathway on Prevention of Catheter Slippage with Intensive Care Unit Patients: A Systematic Review and Meta-Analysis

“…Critically ill patients in ICU generally require various catheters, including tracheal catheters, central venous catheters, gastric tubes, urinary catheters, surgical area drainage tubes, and others. However, in ICU, catheter slippage events occur frequently, affecting the quality of the prognosis of patients [ 25 , 26 ]. Catheter slippage is mainly caused by the accidental shedding of the catheter, but there is also the phenomenon of unauthorized extubation by patients, including the catheter slippage caused by incorrect operation of medical personnel [ 27 , 28 ].…”

Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

“…Unlike usual care treatments, the staff is not frequently present at the bedside, and the communication is hampered. As a result, the frequency of unplanned extubations in COVID-19-infected patients was 13%, which is three times higher than other patients [81]. In this situation, physical restraints were reportedly used in 28% of mechanically ventilated patients [75].…”

Tracheostomy for COVID-19: evolving best practice

“…With the high transmissibility and risk of serious illness, the potential risks to healthcare staff need to be considered in addition to the potential benefits to the patient. One argument surrounds the challenges of primary extubation, with higher rates of reintubation reported in patients with COVID-19 [ 11 ]. Prolonged periods of tracheal intubation associated with the use of neuromuscular blocking agents [ 2 ] and the routine use of systemic corticosteroids [ 12 ] contribute to respiratory muscle deconditioning [ 13 ], which can make going straight from an endotracheal tube to self-supported breathing challenging.…”