Paper: Assessment of a Model for Patients at High Risk for Unplanned Extubations (19th International Nursing Research Congress Focusing on Evidence-Based Practice)

Monday, 7 July 2008

Nancy Tankel, RN, MN , Patient Care Services/Woodland Hills Department of Nursing, Kaiser Permanente, Woodland Hills, CA

Anna Omery, RN, DNSc , Patient Care Services, Kaiser Permanente, Pasadena, CA

Learning Objective 1: identify actual and potential predictors of UEx.

Learning Objective 2: discuss the methodological challenges to investigating UEx.

Though mechanical ventilation is a valuable and often essential tool in the critical care environment, several complications may arise as a result of treatment. One such complication includes unplanned extubations (UEx). UEx is an urgent and emergent event that often contributes to morbidity and mortality, as well as less critical consequences such as pneumonia and increased length of mechanical ventilation. The purpose of this prospective, case controlled, comparative study was to develop and test a model that would identify those patients at high risk for unplanned extubation.

Of the 86 study patients, data for 77 patients were included in the final analysis. Independent variables included age, gender, diagnosis type, time of day the UEx occurred, total ventilated days, previous UEx, level of consciousness, use of restraints, ventilator mode, pH, ventilator changes within the past 24 hours, and APACHE score. Bivariate association with the outcome variable was completed for each independent variable. Of these, only the variables described as “level of consciousness” and “previous UEx” were found to be related statistically to UEx. Logistic regression analysis was completed and no statistical relationship among any of the independent variables was demonstrated. Further analysis of the outcome variable demonstrated that of those who had unplanned extubations, 62% were not reintubated. One can therefore conclude from the lack of significant predictors for UEX in this population, as well as the low frequency of reintubation, that accurate assessment would have been fundamental in the prevention of UEx in this sample. Data collected from this study suggests that clinicians focus their intervention on the assessment of intubated patients and the start of a weaning protocol in order to initiate a planned extubation. Further studies including a larger sample size are warranted in attempts to identify clear predisposing factors of unplanned extubations.

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