- Meeting abstract
An audit of unplanned extubations in a medical intensive care unit
Critical Care volume 4, Article number: P100 (2000)
To study the factors associated with and the outcome of unplanned extubations (UE) in an adult medical intensive care unit (MICU).
Prospective observational study of all patients admitted to an 8 bed university-affiliated MICU from January to December 1998. All patients requiring orotracheal intubation and mechanical ventilation were enrolled at time of the first UE. Information on demographics, disease severity, sedation, ventilator parameters, nursing factors and outcome was captured. Patients were followed up until in-hospital death or hospital discharge.
312 (57.5%) of the 543 patients admitted over the 12 months required intubation and mechanical ventilation. There were 27 (8.7%) events of UE. The mean age of all UE patients was 57.8± 21.0 years with a mean APACHE II score of 18.8± 9.8. The mean number of days prior to UE, mean MICU length of stay (LOS) and mean hospital LOS were 3.2± 3.3, 9.5± 10.4 and 26.0± 34.7 respectively There were observed differences in MICU LOS (12.7± 11.4 versus 3.2± 2.6) and hospital LOS (31.4± 41.2 versus 15.1± 10.8) between the groups who did and did not require reintubation. All 6 deaths came from the group that was reintubated. These 6 patients were not weaning when UE occurred. 17 (63%) of the UE events were deliberate despite 16 (59%) and 20 (74%) of this cohort being on chemical and physical restraints respectively. Nursing ratios of 1 nurse to 2 or 3 patients, depending on shift, were acceptable by our hospital standards and UE events occurred during period of decreased nursing acuity during night shift, change of shift and break time.
8.7% UE, the majority being deliberate, was observed in our MICU. Patients who extubated during ventilator weaning had a better outcome. Windows of decreased nursing acuity may have contributed to the UE. Manpower redistribution during these windows, the adoption of improved sedation titration protocols and protocols to screen patients for readiness for extubation in our MICU may further reduce the risk for deliberate unplanned extubations.