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. 2015 Oct 20;10(10):e0139864.
doi: 10.1371/journal.pone.0139864. eCollection 2015.

Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units

Ming-Lung Chuang  1 , Chai-Yuan Lee  2 , Yi-Fang Chen  3 , Shih-Feng Huang  4 , I-Feng Lin  5
Affiliations

Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units

Ming-Lung Chuang et al. PLoS One. .

Abstract

Most reports regarding unplanned extubation (UE) are case-control studies with matching age and disease severity. To avoid diminishing differences in matched factors, this study with only matching duration of mechanical ventilation aimed to re-examine the risk factors and the factors governing outcomes of UE in intensive care units (ICUs). This case-control study was conducted on 1,775 subjects intubated for mechanical ventilation. Thirty-seven (2.1%) subjects with UE were identified, and 156 non-UE subjects were randomly selected as the control group. Demographic data, acute Physiological and Chronic Health Evaluation II (APACHE II) scores, and outcomes of UE were compared between the two groups. Logistic regression analysis was used to identify the risk factors of UE. Milder disease, younger age, and higher Glasgow Coma Scale (GCS) scores with more frequently being physically restrained (all p<0.05) were related to UE. Logistic regression revealed that APACHE II score (odds ratio (OR) 0.91, p<0.01), respiratory infection (OR 0.24, p<0.01), physical restraint (OR 5.36, p<0.001), and certain specific diseases (OR 3.79-5.62, p<0.05) were related to UE. The UE patients had a lower ICU mortality rate (p<0.01) and a trend of lower in-hospital mortality rate (p = 0.08). Cox regression analysis revealed that in-hospital mortality was associated with APACHE II score, age, shock, and oxygen used, all of which were co-linear, but not UE. The results showed that milder disease with higher GCS scores thereby requiring a higher use of physical restraints were related to UE. Disease severity but not UE was associated with in-hospital mortality.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow Diagram.
The frequencies of annual admission to intensive care units (ICUs), mechanical ventilatory support (MVS), and unplanned extubation (UE). Controls are the subjects without UE.
See this image and copyright information in PMC

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References

    1. de Lassence A, Alberti C, Azoulay E, Le Miere E, Cheval C, Vincent F, et al. (2002) Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: a prospective multicenter study. Anesthesiology 97: 148–156. - PubMed
    1. Penuelas O, Frutos-Vivar F, Esteban A (2011) Unplanned extubation in the ICU: a marker of quality assurance of mechanical ventilation. Crit Care 15: 128 10.1186/cc10049 - DOI - PMC - PubMed
    1. Atkins PM, Mion LC, Mendelson W, Palmer RM, Slomka J, Franko T (1997) Characteristics and outcomes of patients who self-extubate from ventilatory support: a case-control study. Chest 112: 1317–1323. - PubMed
    1. Boulain T (1998) Unplanned extubations in the adult intensive care unit: a prospective multicenter study. Association des Reanimateurs du Centre-Ouest. Am J Respir Crit Care Med 157: 1131–1137. - PubMed
    1. Chevron V, Menard JF, Richard JC, Girault C, Leroy J, Bonmarchand G (1998) Unplanned extubation: risk factors of development and predictive criteria for reintubation. Crit Care Med 26: 1049–1053. - PubMed

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