CHARACTERISTICS AND OUTCOMES OF PATIENTS WHO SELF-EXTUBATE FROM VENTILATORY SUPPORT - A CASE-CONTROL STUDY

Objective: To identify factors associated with the occurrence of delib erate self-extubation and to describe associated patient outcomes. Des ign: Case-control study, Setting: ICUs of a national referral, tertiar y medical center. Participants: Fifty adult, intubated patients who ha d self-extubated from mechanical ventilatory support. Two control subj ects who had not self-extubated were matched to each case based on age , gender, primary discharge diagnosis, and time hospitalized (within s ame quarter). Measurements: Standardized coding of medical record info rmation, including demographic characteristics, clinical information, intubation and mechanical ventilation characteristics, medications, an d selected laboratory indexes. Results: As compared to the control sub jects, patients who self-extubated were more likely to be medical than surgical patients (p < 0.001) and have a current history of smoking ( p < 0.05), Prior to the self-extubation, patients had a greater likeli hood of hospital-acquired infections (p < 0.001) or other hospital-acq uired adverse events (p < 0.001), abnormal (< 10, > 50 mg/dL) BUN (p < 0.05), and abnormal (< 20, > 50 mm Hg) PaCO2 (p < 0.05); they also we re more likely to be restless or agitated (p < 0.001), and more likely to be physically restrained (p < 0.001), A logistic regression model demonstrated that presence of restlessness or agitation and presence o f a hospital-acquired adverse event were independently associated with self-extubation from mechanical ventilatory support. In examining out comes, as compared to the control subjects, those mho self-extubated h ad longer lengths of stay in ICU and hospital, were more likely to nee d reintubation, and were more likely to suffer complications from intu bation. However, none of the cases died within 48 h of self-extubation . Conclusion: The results underscore the need for clinical guidelines for weaning and for monitoring patients at risk of self-extubation.