Unplanned Extubation in the Burn Unit: A Retrospective Review

Unplanned extubation rates in burn patients were previously reported at 27% (3 cases per 100 ventilator days). As facial burns pose a unique challenge to tube securement, patients in our unit have surgically placed bite blocks to secure the endotracheal tube at the provider's discretion. Herein, we assessed unplanned extubation rates at our burn center. We performed a retrospective cohort study including burn patients who required mechanical ventilation from 7/01/2015 to 6/30/2023. Demographics, comorbidities, injuries, and hospital course information were collected and compared between patients who had an unplanned extubation and those who did not. Binary logistic regression analyses were performed to identify factors associated with unplanned extubation and ventilator-associated pneumonia (VAP) complication. P < 0.05 was considered significant. Of 360 patients, 17 (4.7%) had unplanned extubations, representing 0.7 cases per 100 ventilator days. There were no significant differences in demographics, comorbidities, or burn injury characteristics between groups. Patients with unplanned extubation were more likely to have an inhalation injury (70.6% vs 42.6%, P = .001), paCO2 ≥ 50 (70.6% vs 39.1%, P = .031), more ventilator days (6 [2-15] vs 2 [1-4] days, P < .001), and more hospital days (14 [8.5-25.5] vs 8 [2-20], P = .020). Ventilator-associated pneumonia rate tended to be higher in the unplanned extubation group (17.6% vs 5.5%, P = .077). On multivariate analysis, inhalation injury was associated with an increased risk of unplanned extubation (odds ratio (OR) = 4.68 [1.59-13.81], P = .005). No patients with bite blocks had an unplanned extubation. Further study on the utility of advanced securement devices is recommended.