The relationship of sedation to deliberate self-extubation.
OBJECTIVE
To evaluate the relationship between sedative therapy and self-extubation in a large medical-surgical intensive care unit (ICU).


METHODS
Retrospective, case-controlled study.


METHODS
Large teaching hospital.


METHODS
All adult patients who underwent unplanned self-extubation during a 12-month period (n = 50). Each patient was matched to two control patients who did not self-extubate based on age, gender, dates in hospital and diagnosis.


METHODS
none.


METHODS
Data collected included time to self extubation, dosages and types of benzodiazepines, opioid analgesics, antipsychotics, and hypnotics. Data on the degree of agitation as assessed by nursing staff also were obtained.


RESULTS
When compared to controls, patients in the self-extubation group were more likely to have received benzodiazepines (59% vs. 35%; p < 0.05), but equally likely to have received opioids and/or paralytic drugs. Patients who self-extubated were twice as likely as controls to be agitated (54% vs. 22%; p < 0.05). Use of benzodiazepines was more common in agitated patients than in nonagitated patients (62% vs. 35%; p < 0.02). Among nonagitated patients who self-extubated, increased use of benzodiazepines (57% vs. 29%; p < 0.05) was noted when compared to nonagitated controls.


CONCLUSIONS
In intubated ICU patients, benzodiazepines may not consistently treat agitation effectively or prevent self-extubation. Such an effect may be due to paradoxical excitation, disorientation during long-term administration, or differences in drug administration between ICU and operating room (OR) environments.
Department of Anesthesia and Critical Care and Sleep Research Laboratory, University of Chicago, Chicago, IL 60637, USA. atung@airway2.uchicago.edu
A
A
Tung
L
L
Tadimeti
B
B
Caruana-Montaldo
P M
PM
Atkins
L C
LC
Mion
R M
RM
Palmer
J
J
Slomka
W
W
Mendelson
D000368:Aged; D000701:Analgesics, Opioid; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009146:Music; D003473:Neuromuscular Nondepolarizing Agents; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents