[Unplanned extubation in ICU, and the relevance of non-dependent patient variables the quality of care]

Abstract

Objective: To evaluate, for a consecutive year, the magnitude of unplanned extubation, looking for non-dependent patient variables.

Material and methods: Prospective, observational study of cases and controls in a mixed intensive care unit within in a tertiary hospital. Patients were considered cases with more than 24 hours who had an episode of unplanned extubation. Prospective collection of variables case as time of unplanned extubation (collection time), identification of the box where the patient was admitted, presence and type of physical restraint, development of ventilator-associated pneumonia (VAP) and death.

Results: There were 17 unplanned extubation in 15 patients, 1.21 unplanned extubation per 100 days of MV. The unplanned extubation had an inhomogeneous spatial distribution (number of boxes). The time distribution of cases compared with controls showed significant differences in time distribution (P=.02). The comparative analysis between cases and controls, showed increased mortality, increased length of ICU stay, longer hospital stay and increased risk for VAP when patients suffer an episode of unplanned extubation.

Discussion: Unplanned extubation occurs most frequently in a given time slot of the day, may play a role in the spatial location of the patient; occurs most often in patients who are in the process of weaning from mechanical ventilation, and develop greater VAP.

Keywords: Accidental extubation; Auto-extubación; Extubación accidental; Extubación no programada; Marcadores de calidad; Neumonía asociada a ventilación mecánica; Quality of care; Self extubation; Unplanned extubation; Ventilator associated pneumonia.