Characteristics and outcomes of patients who self-extubate from ventilatory support: a case-control study.
OBJECTIVE
To identify factors associated with the occurrence of deliberate self-extubation and to describe associated patient outcomes.


METHODS
Case-control study.


METHODS
ICUs of a national referral, tertiary medical center.


METHODS
Fifty adult, intubated patients who had self-extubated from mechanical ventilatory support. Two control subjects who had not self-extubated were matched to each case based on age, gender, primary discharge diagnosis, and time hospitalized (within same quarter).


METHODS
Standardized coding of medical record information, including demographic characteristics, clinical information, intubation and mechanical ventilation characteristics, medications, and selected laboratory indexes.


RESULTS
As compared to the control subjects, patients who self-extubated were more likely to be medical than surgical patients (p<0.001) and have a current history of smoking (p<0.05). Prior to the self-extubation, patients had a greater likelihood of hospital-acquired infections (p<0.001) or other hospital-acquired adverse events (p<0.001), abnormal (<10, >50 mg/dL) BUN (p<0.05), and abnormal (<20, >50 mm Hg) PaCO2 (p<0.05); they also were more likely to be restless or agitated (p<0.001), and more likely to be physically restrained (p<0.001). A logistic regression model demonstrated that presence of restlessness or agitation and presence of a hospital-acquired adverse event were independently associated with self-extubation from mechanical ventilatory support. In examining outcomes, as compared to the control subjects, those who self-extubated had longer lengths of stay in ICU and hospital, were more likely to need reintubation, and were more likely to suffer complications from intubation. However, none of the cases died within 48 h of self-extubation.


CONCLUSIONS
The results underscore the need for clinical guidelines for weaning and for monitoring patients at risk of self-extubation.
Atkins
P M
PM
Department of Patient Care Operations Management and Infection Control, Cleveland Clinic Foundation, OH 44195, USA.
Mion
L C
LC
Mendelson
W
W
Palmer
R M
RM
Slomka
J
J
Franko
T
T
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004868:Equipment Failure; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome