Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units

Abstract

Most reports regarding unplanned extubation (UE) are case-control studies with matching age and disease severity. To avoid diminishing differences in matched factors, this study with only matching duration of mechanical ventilation aimed to re-examine the risk factors and the factors governing outcomes of UE in intensive care units (ICUs). This case-control study was conducted on 1,775 subjects intubated for mechanical ventilation. Thirty-seven (2.1%) subjects with UE were identified, and 156 non-UE subjects were randomly selected as the control group. Demographic data, acute Physiological and Chronic Health Evaluation II (APACHE II) scores, and outcomes of UE were compared between the two groups. Logistic regression analysis was used to identify the risk factors of UE. Milder disease, younger age, and higher Glasgow Coma Scale (GCS) scores with more frequently being physically restrained (all p<0.05) were related to UE. Logistic regression revealed that APACHE II score (odds ratio (OR) 0.91, p<0.01), respiratory infection (OR 0.24, p<0.01), physical restraint (OR 5.36, p<0.001), and certain specific diseases (OR 3.79–5.62, p<0.05) were related to UE. The UE patients had a lower ICU mortality rate (p<0.01) and a trend of lower in-hospital mortality rate (p = 0.08). Cox regression analysis revealed that in-hospital mortality was associated with APACHE II score, age, shock, and oxygen used, all of which were co-linear, but not UE. The results showed that milder disease with higher GCS scores thereby requiring a higher use of physical restraints were related to UE. Disease severity but not UE was associated with in-hospital mortality.

Reducing Unplanned Extubations in the NICU Following Implementation of a Standardized Approach

“…1 A UE is defined as any unplanned loss of an endotracheal or tracheostomy tube that is used to provide respiratory support or airway stability. 2,3 UEs have been associated with increased ventilator days, 4,5 stay, 4,5 risk of infection, [5][6][7] cardiopulmonary resuscitation, and resuscitation medication usage. A patient who experiences a UE event has the potential for developing hypoxia and hypercarbia.…”

Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation

“…[12,13] We speculate that these variables may not directly indicate the efficacy of oscillation, [29,30] but may be more related to other factors such as disease severity [14] or quality of care. Further longitudinal controlled large-scale studies are warranted to elucidate this issue.…”

Cuidados a pacientes em uso de oxigenação por membrana extracorpórea

“…It was evidenced, in studies, that there is an instability, mainly of the respiratory parameter, during the execution of the nursing care in patients using ECMO. [25][26] There is a need for cooperation between doctors and nurses in the evaluation of patients who use this device to analyze the tolerance level of nursing care. 26 It was evidenced that the daily nursing care protocol is composed of care such as bed bath and lifting with a scoop stretcher (stretcher that allows patient elevation in order to minimize the mobilization of restricted patients in the bed), allowing performing intimate cleaning and removing dirt, changing endotracheal tube positioning and dressing changes as needed.…”