Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units.
Most reports regarding unplanned extubation (UE) are case-control studies with matching age and disease severity. To avoid diminishing differences in matched factors, this study with only matching duration of mechanical ventilation aimed to re-examine the risk factors and the factors governing outcomes of UE in intensive care units (ICUs). This case-control study was conducted on 1,775 subjects intubated for mechanical ventilation. Thirty-seven (2.1%) subjects with UE were identified, and 156 non-UE subjects were randomly selected as the control group. Demographic data, acute Physiological and Chronic Health Evaluation II (APACHE II) scores, and outcomes of UE were compared between the two groups. Logistic regression analysis was used to identify the risk factors of UE. Milder disease, younger age, and higher Glasgow Coma Scale (GCS) scores with more frequently being physically restrained (all p<0.05) were related to UE. Logistic regression revealed that APACHE II score (odds ratio (OR) 0.91, p<0.01), respiratory infection (OR 0.24, p<0.01), physical restraint (OR 5.36, p<0.001), and certain specific diseases (OR 3.79-5.62, p<0.05) were related to UE. The UE patients had a lower ICU mortality rate (p<0.01) and a trend of lower in-hospital mortality rate (p = 0.08). Cox regression analysis revealed that in-hospital mortality was associated with APACHE II score, age, shock, and oxygen used, all of which were co-linear, but not UE. The results showed that milder disease with higher GCS scores thereby requiring a higher use of physical restraints were related to UE. Disease severity but not UE was associated with in-hospital mortality.
Division of Pulmonary Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Critical Care Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Ming-Lung
ML
Chuang
Department of Nursing, Chung Shan Medical University, Taichung, Taiwan.
Chai-Yuan
CY
Lee
Division of Respiratory Care, Chung Shan Medical University Hospital, Taichung, Taiwan.
Yi-Fang
YF
Chen
Division of Pulmonary Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Critical Care Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Shih-Feng
SF
Huang
Institute and Department of Public Health, National Yang Ming University, Taipei, Taiwan.
I-Feng
IF
Lin
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation; D016022:Case-Control Studies; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index