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Multicenter Study
. 2024 Oct;43(5):101411.
doi: 10.1016/j.accpm.2024.101411. Epub 2024 Jul 30.

Prospective multi-center evaluation of the incidence of unplanned extubation and its outcomes in French intensive care units. The Safe-ICU study

Jérémie Guillemin  1 , Benjamin Rieu  2 , Olivier Huet  3 , Léonie Villeret  4 , Stéphanie Pons  1 , Anne Bignon  5 , Quentin de Roux  6 , Raphaël Cinotti  7 , Vincent Legros  8 , Gaëtan Plantefeve  9 , Claire Dayhot-Fizelier  10 , Edris Omar  1 , Cyril Cadoz  11 , Fanny Bounes  12 , Cécile Caplin  13 , Karim Toumert  14 , Thibault Martinez  15 , Damien Bouvier  16 , Maxime Coutrot  17 , Thomas Godet  2 , Pierre Garçon  18 , Jean-Michel Constantin  19 , Mona Assefi  1 , Florian Blanchard  1 ; SFAR research network
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Free article
Multicenter Study

Prospective multi-center evaluation of the incidence of unplanned extubation and its outcomes in French intensive care units. The Safe-ICU study

Jérémie Guillemin et al. Anaesth Crit Care Pain Med. 2024 Oct.
Free article

Abstract

Background: We aimed to determine the epidemiology and outcomes of unplanned extubation (UE), both accidental and self-extubation, in ICU.

Methods: A multicentre prospective cohort study was conducted in 47 French ICUs. The number of mechanical ventilation (MV) days, and planned and unplanned extubation were recorded in each center over a minimum period of three consecutive months to evaluate UE incidence. Patient characteristics, UE environmental factors, and outcomes were compared based on the UE mechanism (accidental or self-extubation). Self-extubation outcomes were compared with planned extubation using a propensity-matched population. Finally, risk factors for extubation failure (re-intubation before day 7) were determined following self-extubation.

Results: During the 12-month inclusion period, we found a pooled UE incidence of 1.0 per 100 MV days. UE accounted for 9% of all endotracheal removals. Of the 605 UE, 88% were self-extubation and 12% were accidental-extubations. The latter had a worse prognosis than self-extubation (34% vs. 8% ICU-mortality, p < 0.001). Self-extubation did not increase mortality compared with planned extubation (8% vs. 11%, p = 0.075). Regardless of the type of extubation, planned or unplanned, extubation failure was independently associated with a poor outcome. Cancer, higher respiratory rate, lower PaO2/FiO2 at the time of extubation, weaning process not-ongoing, and immediate post-extubation respiratory failure were independent predictors of failed self-extubation.

Conclusion: Unplanned extubation, mostly represented by self-extubation, is common in ICU and accounts for 9% of all endotracheal extubations. While accidental extubations are a serious and infrequent adverse event, self-extubation does not increase mortality compared to planned extubation.

Keywords: Accidental extubation; Critical care; Extubation; Extubation failure; Mechanical ventilation; Self-extubation; Unplanned extubation.

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