Risk factors and outcome after unplanned extubations on the ICU, a case-control study.
Crit Care. 2011 Jan 13;15(1):R19
Authors: de Groot RI, Dekkers OM, Herold IH, de Jonge E, Arbous SM
ABSTRACT: INTRODUCTION: Unplanned extubation (UE) is a frequent event during mechanical ventilation in critically ill patients and is possibly associated with increased morbidity and mortality. However, detailed knowledge on risk factors and outcome after UE is lacking. METHODS: A case-control study was performed with a case to control ratio of 1:4. Incidence density sampling was applied. Seventy-four cases and 296 control patients were included. RESULTS: 74 UEs occurred in 69 patients, comprising 2% of all mechanically ventilated patients. Multivariable regression analysis revealed that the first and second category of the Ramsay Sedation Score were associated with a high risk for an UE (odds ratio (OR) = 30, OR = 25, respectively). Male gender, subunit of ICU, length of stay in the ICU and midazolam use at time of UE were also risk factors for an UE. Patients with an UE had lower hospital mortality than mechanically ventilated patients without UE, respectively 10% versus 30%. Forty-seven percent (n = 35) of the patients with an UE had to be reintubated. CONCLUSIONS: The present study showed that the first and second category of the Ramsay Sedation Score were associated with a high risk for an UE. Also male gender and use of midazolam at time of UE were identified as risk factors for an UE. However, compared to mechanically ventilated controls, no increased mortality was shown for UE. In UE patients without need for subsequent reintubation mortality was very low.
PMID: 21232123 [PubMed - as supplied by publisher]