UNPLANNED EXTUBATIONS

Study objective: A prospective study of all unplanned adult extubation s was conducted for 4 months period in four intensive care units (ICUs ) of a community hospital. Our objective was to document the incidence of unplanned extubations, discern possible variables predictive of oc currence and outcome, and formulate preventive measures and guidelines for reintubation. Design: Prospective case series. Setting: Hospital with 525 beds and four ICUs: medical-surgical-trauma, neurology-neuros urgery, cardiovascular, and coronary care. Patients: All adult patient s intubated in four ICUs for a 4-month period. Interventions: None. Me asurements and results: Of 460 adults intubated in the 4-month period, 13 (3 percent) unplanned extubations occurred. Six patients were rein tubated because of apnea, tachypnea, hypoxia, or other factors. Seven were not reintubated. Variables examined included the ventilator setti ngs before to self-extubation, duration of intubation, arterial blood gases after self-extubation, Glasgow Coma Scale and Acute Physiology a nd Chronic Health Enquiry (APACHE) scores, lime and location (ICU), na sal or oral method of intubation, and the mechanism of self-extubation . Conclusions: Our data suggested that self-extubation is relatively r are in our institution and that about half of self-extubated patients were reintubated. Staff vigilance, a proper weaning period, and the na sal method of intubation were some of the factors to which we attribut ed this low occurrence rate. However, a larger patient study populatio n is required to show conclusively effective preventive measures and e stablish guidelines for reintubation.