Incidence and risk factors of unplanned extubation in critically ill surgical patients: The multi-center thai university-based surgical intensive care units study (THAI-SICU study)

Abstract

© 2016, Medical Association of Thailand. All rights reserved. Objective: Unplanned extubation (UE) is one of the most troubling events in critically ill patients who require endotracheal intubation and mechanical ventilation. The aims of this study are to determine the incidence and to identify the risk factors associated with UE in critically ill surgical patients. Material and Method: This was a multi-center prospective observational cohort study, which included surgical patients admitted to nine university-based surgical intensive care units (SICUs) in Thailand between April 2011 and January 2013. UE was defined as deliberate extubation by patients (self-extubation) or accidental extubation during procedures or transportation. The incidence of UE was calculated, the adjusted logistic regression model was performed to determine the independent risk factors for UE and the outcomes were compared between those with planned extubation and UE. Results: 2,890 patients required endotracheal intubation and mechanical ventilation were included in the analysis. Of these, 54 patients experienced UE and, therefore, the incidence of UE was 1.9%. Five independent risk factors for UE were identified; congestive heart failure (adjusted odds ratio, OR, 3.48; 95% CI, 1.29-9.40), emergency surgery (adjusted OR, 2.18; 95% CI, 1.01-4.74), non-postoperative status (adjusted OR, 2.37; 95% CI, 1.05-5.37), sedation usage (adjusted OR, 3.19; 95% CI, 1.72-5.93) and delirium (adjusted OR, 3.61; 95% CI, 1.71-7.60). ICU length of stay (LOS) was significantly longer in patients with UE than those with planned extubation (adjusted coefficient, 2.76; 95% CI, 1.34-4.19). There was no significant difference between the two groups in terms of hospital LOS as well as ICU and 28-day mortality. Conclusion: The incidence of UE in critically ill surgical patients was 1.9%. Five independent risk factors for UE were: underlying congestive heart failure, emergency surgery, non-postoperative status, sedation usage, and delirium. Patients with UE had significantly longer ICU LOS than those with planned extubation.