Revisiting endotracheal self-extubation in the surgical and trauma intensive care unit: Are they all fine?
OBJECTIVE
Endotracheal self-extubation (ESE) is a serious health care concern. We designed this study to test our hypothesis that not all patients with ESE are successful in spontaneous breathing and reintubation has negative impact on outcomes.


METHODS
Data on all 39 patients of ESE in our surgical and trauma intensive care unit (ICU) in 2012 were prospectively collected and retrospectively analyzed.


RESULTS
There were 42 episodes of ESE in 39 of 939 intubated patients (frequency, 4.0%), with 54% of events requiring reintubation. Pre-ESE positive end-expiratory pressure was higher and Pao2/fraction of inspired oxygen ratio was lower, and the post-ESE respiration rate was higher in the reintubated group. On univariate analysis, weaning and spontaneous breathing trial before ESE were favorable predictors for nonreintubation. Multivariate regression analysis demonstrated that agitation before ESE was an independent predictor of reintubation. The need for reintubation was associated with increased risk of pulmonary infectious complications, ventilator days, the need for tracheostomy, and ICU and hospital LOS. The financial costs for ventilator days and ICU rooms were significantly higher in patients with reintubation.


CONCLUSIONS
Not all patients were fine after ESE. We have not decreased the frequency of ESE or improved outcomes if the patients were reintubated. The need for reintubation was not only associated with a high pulmonary complication rate but also prolonged duration on mechanical ventilation and hospital/ICU stay and increased the hospital costs.
Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY.
Ashleigh M
AM
Fontenot
Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY.
Robert A
RA
Malizia
Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY.
Michael S
MS
Chopko
Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY.
William J
WJ
Flynn
Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY.
James K
JK
Lukan
Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY.
Charles E
CE
Wiles
Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY. Electronic address: waguo@buffalo.edu.
Weidun Alan
WA
Guo
D000328:Adult; D000368:Aged; D060666:Airway Extubation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D056152:Respiratory Rate / Q000502:physiology; D012189:Retrospective Studies; D014139:Tracheostomy / Q000706:statistics & numerical data
Self-extubation; reintubation; ventilation