Risk factors of self-extubation in intensive care. Retrospective cohort study
Abstract
Introduction: Acute respiratory failure remains one of the three leading causes of admission to the intensive care unit (ICU). Self-extubation is an adverse outcome requiring reintubation in 50% of cases.
Objective: To assess for determinants (risk factors) of self-extubation and mortality in the ICU by using a generalized estimation equation model (GEE).
Methods: The data was collected from a retrospective cohort study from 2017-2020 including all patients admitted to the ICU with mechanical ventilation. Univariate and bivariate analyses were performed. Then, a GEE model was conducted to predict the risk of self-extubation and mortality.
Results: A total of 857 subjects were included, with a mean age of 60.5 +/- 17 years-old. Most of the subjects were males (55.2%). An 8.99-fold risk (95%CI 3.83-21.1, p<0.01) of self-extubation was identified in patients with agitation. Exposure to infusion of neuromuscular blockade was also found to increase the risk of self-extubation 3.37 times (95%CI 1.31-8.68, p=0.01). No associations were identified between immobilization and self-extubation (OR 1.38 95%CI 0.76-2.51, p=0.29). Finally, light sedation according to the Richmond Sedation Scale (RASS) between 0 to -2 rather than moderate (RASS-3) reduces the risk of mortality (OR 0.57, 95%CI 0.38-0.83, p<0.01).
Conclusions: The main factors resulting in self-extubation were: agitation, delirium, and infusion of neuromuscular blocking agents. An association was found between light sedation and a lower risk of mortality. No association was found between the use of physical restraint and the desired outcome.
References
Reisner-Sénélar L. The birth of intensive care medicine: Björn Ibsen’s records. Intensive Care Med. 2011;37(7):1084–6. doi: https://doi.org/10.1007/s00134-011-2235-z
Bohula EA, Katz JN, Van Diepen S, Alviar CL, Baird-Zars VM, Park JG, et al. Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units: The Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness. JAMA Cardiol. 2019;4(9):928–35. doi: https://doi.org/10.1001/jamacardio.2019.2467
Chang LY, Wang KW, Chao YF. Influence of physical restraint on unplanned extubation of adult intensive care patients: a case-control study. Am J Crit Care. 2008;17(5):408–15. doi: https://doi.org/10.4037/ajcc2008.17.5.408
Chao CM, Lai CC, Chan KS, Cheng KC, Ho CH, Chen CM, et al. Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units: A 15-year experience. Med. 2017;96(27):e6877. doi: https://doi.org/10.1097/MD.0000000000006877
Da Silva PSL, Fonseca MCMH. Unplanned endotracheal extubations in the intensive care unit: Systematic review, critical appraisal, and evidence-based recommendations. Anesth Analg. 2012;114(5):1003–14. doi: https://doi.org/10.1213/ANE.0b013e31824b0296
Cohn JE, Touati A, Lentner M, Weitzel M, Fisher C, Sataloff RT. Self-extubation Laryngeal Injuries at an Academic Tertiary Care Center: A Retrospective Pilot Study. Ann Otol Rhinol Laryngol. 2017;126(7):555–60. doi: https://doi.org/10.1177/0003489417709795
Gueret RM, Tulaimat A, Morales-Estrella JL. Self-extubation revisited: A case-control study. Respir Care, 2020;65(9):1301–8. doi: https://doi.org/10.4187/respcare.07007
Kwon EO, Choi KS. Case-control Study on Risk Factors of Unplanned Extubation Based on Patient Safety Model in Critically Ill Patients with Mechanical Ventilation. Asian Nurs Res (Korean Soc Nurs Sci). 2017;11(1):74–8. doi: https://doi.org/10.1016/j.anr.2017.03.004
De Groot RI, Dekkers OM, Herold IHF, de Jonge E, Arbous MS. Risk factors and outcomes after unplanned extubations on the ICU: A case-control study. Crit Care. 2011;15(1):1–9. doi: https://doi.org/10.1186/cc9964
Ai ZP, Gao XL, Zhao XL. Factors associated with unplanned extubation in the Intensive Care Unit for adult patients: A systematic review and meta-analysis. Intensive Crit Care Nurs. 2018;47:62–8. doi: https://doi.org/10.1016/j.iccn.2018.03.008
Burry L, Rose L, Ricou B, Physical restraint : time to let go. Intensive Care Med. 2018;44(8):1296–8. doi: https://doi,org/10,1007/s00134-017-5000-0
Chuang ML, Lee CY, Chen YF, Huang SF, Lin IF. Revisiting unplanned endotracheal extubation and disease severity in intensive care units. PLoS One. 2015;10(10). doi: https://doi.org/10.1371/journal.pone.0139864
Chhina AK, Loyd GE, Szymanski TJ, Nowak KA, Peruzzi WT, Yeldo NS, et al. Frequency and Analysis of Unplanned Extubation in Coronavirus Disease 2019 Patients. Crit Care Explor. 2020;2(12):e0291. doi: https://doi.org/10.1097/CCE.0000000000000291
Instituto Nacional de Salud, Boletín Epidemiológico Marzo 2020. Instituto Nacional de Salud, 2020. Colombia. [Internet]. [Citado 14 Sep 22]. Disponible en: https://doi.org/10.33610/23576189.2020.14
Díaz M del P. Construcción de modelos GEE para variables con distribución simétrica. Rev Soc Argent Estad. 2016;9:1–18.
The National Heart, Lung and BIPCTN. Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome. N Engl J Med. 2019;380(21):1997–2008. doi: https://doi.org/10.1056/NEJMoa1901686
Salehi Z, Joolaee S, Hajibabaee F, Ghezeljeh TN. The challenges of using physical restraint in intensive care units in Iran: A qualitative study. J Intensive Care Soc. 2021;22(1):34–40. doi: https://doi.org/10.1177/1751143719892785
Ye J, Wang C, Xiao A, Xia Z, Yu L, Lin J, et al. Physical restraint in mental health nursing: A concept analysis, Int J Nurs Sci. 2019;6(3):343–8. doi: https://doi.org/10.1016/j.ijnss.2019.04.002
Acar Sevinc S, Metin S, Balta Basi N, Cinar AS, Turkel Ozkan M, Oba S. Anxiety and burnout in anesthetists and intensive care unit nurses during the COVID-19 pandemic: a cross-sectional study. Brazilian J Anesthesiol. 2021;72(2):169-75. doi: https://doi.org/10.1016/j.bjane.2021.07.011
Acevedo-Nuevo M, Via-Clavero G. La reducción del uso de contenciones mecánicas, una asignatura pendiente y emergente en las UCI. Med Intensiva. 2019;43(5):299–301. doi: https://doi.org/10.1016/j.medin.2018.09.005
Sessler CN. Train-of-Four To Monitor Neuromuscular Blockade?. Chest. 2004;126(4):1018–22. doi: https://doi.org/10.1378/chest.126.4.1018
Severgnini P, Pelosi P, Contino E, Serafinelli E, Novario R, Chiaranda M. Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: Prospective, observational study, J Intensive Care. 2016;4(1):1–8. doi: https://doi.org/10.1186/s40560-016-0192-x
Downloads
Copyright (c) 2022 Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
