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

Friday, 25 July 2014: 10:45 AM

Eunok Kwon, PhD, RN, CCNS
Nursing department of Seoul National University Hospital, Seoul National University Hospital, Seoul, South Korea
Kyung Sook Choi, PhD, RN
Department of Nursing, Chung Ang University, Seoul, South Korea


 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.