PROSPECTIVE EVALUATION OF SELF-EXTUBATIONS IN A MEDICAL INTENSIVE-CARE UNIT

Objective: To evaluate the incidence, associated factors and gravity o f self-extubations. Design: Prospective study about all patients intub ated over an 8 month period. Setting: A medical intensive care unit of a University Hospital Patients: Patients were divided into two groups : self-extubated and those that did not. The self-extubations were sep arated into deliberate acts by the patients and accidental. Results: 2 4 of the 197 patients included presented a total of 27 extubations (12 %). There were 21 deliberate incidents and 6 accidental. The only diff erences between the cases and the rest of the population were a higher mean age (67 vs 59 years) and a larger proportion of chronic respirat ory failure (66% versus 35%). Reintubation was necessary in 20 cases ( 74%) within 30 min in 16 cases. The main indication for reintubation w as acute respiratory distress (90%). Reintubation was associated with one death. Conclusion: Self-extubation is a frequent and serious compl ication of mechanical ventilation. Deliberate self-extubation, the mos t frequent type of incident could possibly be reduced by better sedati on of agitated patients and accidental self-extubation by better train ing of the nursing staff.