The drive to survive: unplanned extubation in the ICU.

ABSTRACT

STUDY OBJECTIVES: To assess the consequences of unplanned extubation (UE) in the ICU. DESIGN: Case-control study. SETTING: Fourteen-bed, medical-surgical ICU of a university-affiliated community teaching hospital. PATIENTS One hundred patients who underwent UE compared to 200 control patients who underwent mechanical ventilation (MV) without UE between January 1, 1999, and June 30, 2004. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Patients with UE had longer ICU and hospital length of stay (LOS) and longer duration of MV than did control subjects. Hospital mortality was 20% among UE and 35% among control patients (p = 0.011). Of the 100 patients with UE, reintubation within 48 h (UE R+) was required in 44 patients and no reintubation within 48 h (UE R-) was required in 56 patients. ICU and hospital LOS; duration of MV; rate of ICU-acquired infections; ICU pharmacy, laboratory and diagnostic imaging charges; and mortality were all much higher among UE R+ patients than among UE R- patients. Multiple logistic regression analysis revealed that age was the only predictor of the need for reintubation after UE and that age and the need for reintubation were the only predictors of mortality after UE. CONCLUSIONS: UE was associated with increased hospital and ICU LOS but decreased mortality in this heterogeneous population of critically ill adult patients. These findings were entirely explained by the divergent outcomes of the UE R+ and UE R- groups. Patients with UE who did not require reintubation had remarkably good outcomes. It remains incumbent on ICU teams to institute protocols for regular identification of patients ready to be liberated from MV.