RESUMO
BACKGROUND: Unplanned extubations (UEs) in injured patients are potentially fatal, but etiology and patient characteristics are not well described. We have been prospectively characterizing the etiology of UEs after we identified a high rate of UEs and implemented an educational program to address it. This period of monitoring included the years of the COVID-19 pandemic that produced high rates of workforce turnover in many hospitals, dramatically affecting nursing and respiratory therapy services. We hypothesized that frequency of UEs would depend on the etiology and that the workforce changes produced by the COVID-19 pandemic would increase UEs. METHODS: This study was a prospective tracking and retrospective review of trauma registry and performance improvement data from 2012-2021. RESULTS: UE subjects were younger, were more frequently male, were diagnosed more frequently with pneumonia (38% vs 27%), and had longer hospital (19 d vs 15 d) and ICU length of stay (LOS) (12 d vs 10 d) (all P < .05). Most UEs were due to patient factors (self-extubation) that decreased after education, while UEs from other etiologies (mechanical, provider) were stable. Subjects with UEs from mechanical or provider etiologies had longer ICU LOS, higher mortality, and were less likely to be discharged home. The COVID-19 pandemic was associated with more total patient admissions and more days of ventilator use, but the rate of UEs was not changed. CONCLUSIONS: UEs were decreased by education with ongoing tracking, and UEs from patient factors were associated with better outcome than other etiologies. Workforce changes produced by the COVID-19 pandemic did not change the rate of UEs.
RESUMO
BACKGROUND: Acute Kidney Injury (AKI) is associated with significant morbidity. The risk factors for AKI in elderly trauma patients have not been defined. METHODS: Injured patients 75 years old or older from 2014 to 2016 were evaluated. AKI was identified by RIFLE criteria. Patients with and without AKI were compared with chi square, ANOVA, and logistic regression. RESULTS: 836 patients were 75 years old or older. Patients with AKI were more commonly male, hypotensive on admission with a greater Injury Severity Score but age, diabetes, hypertension and baseline creatinine were similar. Patients with AKI had a higher mortality that did not increase with RIFLE stage. Male sex, ISS, hypotension on admission and presence of an extremity injury were independently associated with AKI by logistic regression. CONCLUSION: AKI in elderly trauma patients is associated with magnitude of injury and shock but not pre-existing medical comorbidities and it significantly increased the risk of death.
