UNPLANNED EXTUBATIONS IN THE ADULT INTENSIVE-CARE UNIT - A PROSPECTIVE MULTICENTER STUDY

The predisposing factors and complications of unplanned extubation (UE X) in mechanically ventilated adult patients are not well recognized. We designed a prospective multicenter observational study to identify risk factors and describe the complications of UEX. We followed 426 ve ntilated patients over a 2-mo period. Clinical characteristics such as diagnosis on admission and reasons for ventilation were used to class ify the patients. The presence or absence of potential risk factors wa s daily noted, including the types of ventilators, tracheal tubes, tub e fixations, ventilatory support modes, route for intubation, and the use of intravenous sedation. Circumstances and complications of UEX we re prospectively recorded. Forty-six (10.8%) patients experienced at l east one episode of UEX. Ten UEX occurred during nursing procedures. A t the moment of UEX, 61% of patients were agitated. The rates of morta lity, laryngeal complications, nosocomial pneumonia after extubation, and the length of mechanical ventilation were similar in UEX and non-U EX patients. Patients were more often reintubated after UEX (28 of 46) than after planned extubation (28 of 284). All the non-reintubated UE X patients survived. One death occurred as a direct consequence of UEX . By use of multivariate analysis, we identified four factors contribu ting to UEX: chronic respiratory failure, endotracheal tube fixation w ith only thin adhesive tape, orotracheal intubation, and the lack of i ntravenous sedation. Considering these factors, we hypothesized that s imple measures should be adopted to minimize the incidence of UEX and its related complications: more vigilance during procedures at patient s' bedsides, adequate sedation of agitated patients, strong fixation o f the tracheal tube, particular attention paid to orally intubated pat ients, and daily reassessment of the possibility of weaning from the v entilator.