Respiratory management after self-extubation.
OBJECTIVE
Self-extubation is a potentially life-threatening event, but may also provide an opportunity to wean patients who should have been extubated earlier. The purpose of this study was to determine the risk factors for re-intubation after self-extubation.


METHODS
The medical charts of 69 self-extubated patients treated in Shin Kong Hospital, Taipei, from September 1996 through August 1998 were reviewed. Demographic data, ventilator settings before self-extubation, arterial blood gas values, and the type of respiratory management used after self-extubation were examined to determine their association with re-intubation.


RESULTS
Of the 69 self-extubated patients, 38 fared well without further ventilatory support after self-extubation. Four factors were associated with extubation outcome: 1) mean pre-extubation FiO2 (fraction of inspired oxygen), which was significantly higher in the re-intubated group (RI) than in the not re-intubated group (NRI) (0.48 vs 0.33, p = 0.002)--all self-extubated patients receiving an FiO2 of more than 0.40 were re-intubated; 2) PaO2/FiO2 (ratio of arterial oxygen tension to inspired oxygen concentration), which was lower in the RI group than in the NRI group (259.4 vs 346.4, p = 0.005); 3) requirement for assist/control ventilatory mode--patients needing this type of ventilatory support had a greater likelihood of reintubation than those requiring partial ventilatory support (odds ratio [OR], 3.790; confidence interval [CI], 1.055-13.621; p = 0.041); and 4) female sex (OR 0.188; CI 0.048-0.732; p = 0.016).


CONCLUSIONS
About half of self-extubated patients may not require re-intubation. Pre-extubation FiO2, PaO2/FiO2, and ventilator mode, as well as gender, may be useful in determining the likelihood that a self-extubated patient will require re-intubation.
Jiang
J S
JS
Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Kao
S J
SJ
Lin
C M
CM
Yeh
Y W
YW
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012119:Respiration; D012121:Respiration, Artificial; D012737:Sex Factors