Indian Journal of Critical Care Medicine

Abstract

Background and Aims:Tracheal tubes are commonly used in intensive care unit (ICU) and lead to complications like displacements. The primary aim of the study was to evaluate if the rate of tracheal tube displacement benchmarked at <1% per patient and <0.5% per tracheal tube day, could be sustained over a prolonged period. The secondary aim was to document the patterns of all forms airway accident and to evaluate their consequences.Subjects and Methods:This was a prospective observational study of Intubated and ventilated patients in a General Medical-Surgical Adult ICU. The incidence of accidental extubation, self extubation, partial displacement and blockages of tracheal tubes were recorded.Results:The overall tracheal tube displacement rate was 61/10,112 (0.6%) per patient and 61/28,464 (0.22%) per tracheal tube day. There were 30 additional incidents of blockage, kinking or biting of the tracheal tube. Physiological consequences-69 were mild, 10 moderate, 12 major and one death. Of the 91 accidents, 30 were partly and 30 were completely preventable. 76 incidents involved an endotracheal tube (54 displaced, 12 blocked and 10 bitten-kinked) and 15 a tracheostomy tube (seven displaced and eight blocked). Accidents were more common in medical than surgical patients (medical = 48, cardiac surgical = 17 and other surgical/trauma = 26).Conclusion:Tracheal tube displacement rate in a mixed medical-surgical adult ICU was maintained below the pre-set benchmark of <1% per patient and <0.5% per intubated day over nearly a decade.

An overview of complications associated with open and percutaneous tracheostomy procedures

“…The reported incidence of tube displacement varies in the literature, but generally falls in the range of 0.35–2.6%. [ 5 43 44 45 46 47 48 ] However, there have been reports of rates as high as 15%. [ 49 ] Although the rate of tube displacement is low, inadvertent displacement carries one of the highest mortalities of any tracheostomy complication and is reported as high as 25–100%.…”

Unplanned extubation: securing the tool of our trade

“…Type of study Year Age group UER Notes Vianna et al [6] Retrospective 2007 Adult 2 % of intubated patients Yeh et al [7] Questionnaire 2004 Adult 22.5 % of intubated patients Kapadia et al [8] Prospective observational 2014 Adult 0.22 % per bed endotracheal day Razavi et al [9] Prospective cohort controlled 2013 Pediatric 3.6 % per intubated bed patient day…”

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

“… UEs: SE if the patient intentionally removed the tube or accidental extubation (AE) if caused during movement for any reason Blocked tubes (blocked endotracheal tube [BET]; blocked TT [BTT]): Diagnosed if manual bag ventilation became difficult or mechanical ventilation showed high airway pressure or by noting that the lumen of the replaced tracheal tube was occluded requiring reintubation Displacement of tracheal tube: If the tip was seen displaced above vocal cords on laryngoscopy Endobronchial intubations: Diagnosed on auscultation when the air entry was not equal bilaterally Kinked tubes: Diagnosed by direct visualization under laryngoscopy Leaking cuffs: Diagnosed if there was large tidal volume leak compromising effective ventilation. [ 14 ] …”

“…Leaking cuffs: Diagnosed if there was large tidal volume leak compromising effective ventilation. [ 14 ]…”

“…Indian studies on airway accidents in an Intensive Care Unit (ICU) or CCU are limited. [ 1 2 14 ] Exhaustive search in PubMed with keywords namely “airway accidents,” “unplanned extubations,” and “blocked tubes” revealed no published studies from Eastern India. To address this lacunae in literature, we carried out a retrospective study of all tracheal tube related accidents over 3 years (January 2012–December 2014) in a 5-bedded CCU (medical and surgical) under the Department of Anaesthesiology, Pain and Critical Care Medicine of a Government Teaching Hospital of Eastern India to evaluate the incidence, type, and medical impact of such accidents.…”