Risk factors of self-extubation in intensive care. Retrospective cohort study

  • Carlos Eduardo Laverde-Sabogal a. Intensive Care, Department of Internal Medicine, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia. b. Hospital Universitario San Ignacio, Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0000-0001-6017-3059
  • Carmelo José Espinosa-Almanza School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0000-0002-9148-1289
  • Daniela Patiño-Hernández Department of Internal Medicine. Hospital Universitario San Ignacio, Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0000-0003-4911-3869
  • Horacio Rodríguez-Escallón Intensive Care Unit. Hospital Universitario San Ignacio, Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0000-0001-8913-1354
  • Juan Camilo Aguado-Valderrama School of Medicine, Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0000-0002-0039-0876
  • Paula Lara-Monsalve Department of Anesthesiology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana. Bogotá, Colombia.
Keywords: Airway extubation, Artificial respiration, Critical care, Self-Extubation, Anesthesiology

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.

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How to Cite
1.
Laverde-Sabogal CE, Espinosa-Almanza CJ, Patiño-Hernández D, Rodríguez-Escallón H, Aguado-Valderrama JC, Lara-Monsalve P. Risk factors of self-extubation in intensive care. Retrospective cohort study. Colomb. J. Anesthesiol. [Internet]. 2022 Sep. 15 [cited 2024 May 30];51(2). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1050

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Published
2022-09-15
How to Cite
1.
Laverde-Sabogal CE, Espinosa-Almanza CJ, Patiño-Hernández D, Rodríguez-Escallón H, Aguado-Valderrama JC, Lara-Monsalve P. Risk factors of self-extubation in intensive care. Retrospective cohort study. Colomb. J. Anesthesiol. [Internet]. 2022 Sep. 15 [cited 2024 May 30];51(2). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1050
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