A Case-Control Study on Predictors and Outcomes of Unplanned Extubation in Mechanically Ventilated Critically Ill Patients

Abstract

Session presented on Friday, July 25, 2014: Purpose: To find out predictors & outcomes of unplanned extubation in mechanically ventilated critically ill patients. Methods: Researcg design is a case-control study over 3 years period from January 1, 2010 through December 31, 2012. Settings is A 62-beds medical & surgical intensive care unit of 1800 beds tertiary hospital. Data were retrospectively collected from electronic medical records. A total 230 episodes of deliberate unplanned extubation in 242 patients from 41,207 mechanically ventilated patients for 3 years (frequency 0.53%). 460 episodes in 460 patients with planned extubation age, gender & diagnosis-matched controls were analyzed in this case-control study. Results: Predictors associated with unplanned extubation include better motor response (OR 1.3), admission route via ER (OR 1.8), higher APACHE IIscore (1.061), mode of mechanical ventilation (CPAP, PSV: OR4.1, SIMV:3.0), peripheral O2 saturation (OR:0.9), heart rate (OR: 1.0), respiration rate (OR:1.0), pain (OR:0.3), agitation (OR:9.0), delirium (OR:11.6), night shift (OR:6.0) and morning care time (OR:0.5). The patients' & organizational outcomes of unplanned extubation were reintubation (OR;85.66), a poor discharge result (OR:0.2), a longer length of stay in the ICU (adj R-square:7%) and a longer length of stay in the hospital (adj R-square:4.3%). Conclusion: Delirium, agitation, ventilation mode and night shift are high predictive factors of unplanned extubation. The outcomes of unplanned extubation were increasing reintubation, a poor patient outcome at the time of discharge and poor organizational outcome including longer length of stay in the ICU and hospital.