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.