MED-6. Case control study evaluating factors and outcomes of patients with unplanned endotracheal extubation: 11 month experience.

Unplanned extubation (UXT) may be a life-threatening event or may identify patients who should have been weaned from the ventilator earlier. Studies in the past have revealed incidence, risk factors, outcome and impact on length of stay. However, patient characteristics including severity of illness and APACHE II score are not well established. To further identify the correlation and utility of these factors we undertook a 5-year case control study. Data are gathered by the respiratory therapist, using a modified worksheet utilized in prior studies. Acquisition began in March 2003 of patients who had UXT as well as patients who had planned extubation with similar characteristics as the study group. The first 11 months revealed 16 UXT. One event was eliminated from the study due to incomplete data. From the 15 cases one was an accidental extubation during transport; leaving 14 of 15 that "self-extubated." Eight of 15 UXT required re-intubation of which seven were due to respiratory failure and one to airway protection. Three of the re-intubated patients had further complications: bleeding, aspiration and death. One of the deaths was within 48 hours of extubation. From the 15 UXT, 8 were post-operative cases, of which 3 needed to be reintubated. Four of the 15 UXT were not receiving sedation at the time of extubation. From these four cases, three were actively been weaned off from the ventilator. In our review thus far our incidence of reintubation (53%) is similar to previous investigations, 86% were by manual self-extubation with no correlation with restraints, severity of illness or APACHE score. Cases differ from previous studies in that they have been more likely to be surgical than medical and have had more deaths. Thus far, no particular risk factor has been identified as the most likely reason for UXT.

Andres C. Marte Grau, MD, Saleem Qureshi, MD, James Franko, MD, Tom Terris, RT, and Nicky Atkinson, RT. University of Virginia Roanoke-Salem, Carilion Roanoke Memorial Hospital, Roanoke, VA.