A PROSPECTIVE-STUDY OF UNPLANNED ENDOTRACHEAL EXTUBATION IN INTENSIVE-CARE UNIT PATIENTS

Objective: To evaluate incidence, factors associated with unplanned en dotracheal extubation (UEE), and prognostic factors for reintubation. Design: A prospective study over a 32-mo period. Setting: A 16 bed gen eral intensive care unit of a tertiary university hospital. Patients: Adult subjects undergoing endotracheal intubation for >48 hrs. Interve ntions: Observation of patients who presented unplanned extubation. Me asurements and Main Results: Over the 32-mo period, there were 59 epis odes of UEE in 55 patients (frequency 7.3%). Deliberate self-extubatio n occurred in 46 episodes (77.9%), while there were 13 episodes (22.1% ) of accidental extubation. Twenty-seven (45.8%) episodes occurred in patients who were receiving full mechanical ventilatory support and 32 (54.2%) episodes occurred during the weaning period from mechanical v entilation. Reintubation was required in 27 (45.8%) episodes of UEE. T he need for reintubation after UEE was 36.9% in deliberate self-extuba tion patients and 76.9% in accidental extubation patients (p = .01). O nly 15.6% (5/32) of patients who presented UEE during weaning required reintubation, while reintubation was mandatory in 81.5% (22/27) of pa tients who presented UEE during full mechanical ventilatory support (p < .001). A multiple logistic regression analysis was performed to det ermine the variables independently associated with the need for reintu bation: days of mechanical ventilation were significantly associated w ith the need for reintubation, and weaning was associated with no need for reintubation. The model correctly classified the need for reintub ation in 84.7% (50/59) of cases. Conclusions: Reintubation in UEE pati ents strongly depends on the type of mechanical ventilatory support. T he probability of requiring reintubation if UEE occurs during full ven tilatory support is higher than if UEE occurs during weaning. These da ta suggest that some patients are under mechanical ventilation longer than necessary.