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Unplanned extubation: a local experience
1Department of Respiratory Medicine, Tan Tock Seng Hospital, 11 Jalan Tan, Tock Seng, Singapore 308433. lee_lan_phoa@ttsh.com.sg
Objectives:
To study the outcome of unplanned extubation (UE) in the Medical Intensive Care Unit (MICU) and to identify factors which predict the need for reintubation.
Methods:
A prospective study of all mechanically ventilated patients admitted to MICU in 1998. Patients were enrolled into the study at the point of their first UE. The primary endpoint was reintubation after UE and secondary endpoint was death from any cause during hospitalisation.
Results:
A total of 543 patients were admitted to MICU of which 312 were mechanically ventilated. UE accounted for 8.7% of our mechanically ventilated patients. The mean APACHE 11 score was 20 (+/- 10), mean time between intubation and UE was 3.1 days (+/- 3.1), mean length of MICU stay was 10.1 days (+/- 10.2) and mean hospital stay was 27.0 days (+/- 36.1). Eighty-seven percent of the UE was deliberate. The rate of reintubation after failed UE was 58.3% of which 71.4% had immediate reintubation. Twenty-nine percent of patients were undergoing weaning during UE. The in-hospital mortality was 25%. All deaths occurred in the group who failed UE. Patients who failed UE had a higher mean APACHE 11 score, a higher mean pre-extubation FiO2 level and a lower mean PaO2/ FiO2 ratio (p < 0.05).
Conclusion:
UE accounted for 8.7% of our mechanically ventilated patients and 58.3% of these patients required reintubation. Failed UE was associated with a higher mortality. A higher APACHE 11 score, higher pre-extubation FiO2 level and a lower PaO2/FiO2 ratio were associated with reintubation after failed UE.