A Case-Control Study on Predictors and Outcomes of Unplanned Extubation in Mechanically Ventilated Critically Ill Patients

Purpose:

 To find out predictors & outcomes of unplanned extubation in mechanically ventilated critically ill patients.

Methods: Researcg design is a case-control study over 3 years period from January 1,2010 through December 31,2012. Settings is A 62-beds medical & surgical intensive care unit of 1800 beds tertiary hospital. Data were retrospectively collected from electronic medical records. A total 230 episodes of deliberate unplanned extubation in 242 patients from 41,207 mechanically ventilated patients for 3 years(frequency 0.53%). 460 episodes in 460 patients with planned extubation age, gender & diagnosis-matched controls were analyzed in this case-control study.

Results: Predictors associated with unplanned extubation include better motor response (OR 1.3), admission route via ER(OR 1.8),higher APACHE IIscore(1.061), mode of mechanical ventilation (CPAP, PSV: OR4.1, SIMV:3.0), peripheral O₂ saturation(OR:0.9), heart rate(OR: 1.0), respiration rate(OR:1.0), pain (OR:0.3), agitation(OR:9.0), delirium(OR:11.6), night shift(OR:6.0)and morning care time(OR:0.5). The patients’ & organizational outcomes of unplanned extubation were reintubation(OR;85.66), a poor discharge result(OR:0.2), a longer length of stay in the ICU (adj R-square:7%)and a longer length of stay in the hospital(adj R-square:4.3%).

 Conclusion: Delirium, agitation, ventilation mode and night shift are high predictive factors of unplanned extubation. The outcomes of unplanned extubation were increasing reintubation, a poor patient outcome at the time of discharge and  poor organizational outcome including longer length of stay in the ICU and hospital.