Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
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ORIGINAL ARTICLE
Year : 2006  |  Volume : 1  |  Issue : 2  |  Page : 71-75

Unplanned extubation in the ICU: Impact on outcome and nursing workload


1 King Khalid National Guard Hospital, King Abdulaziz, Medical City - Jeddah, Saudi Arabia
2 Program in Critical Care, London Health Sciences Centre, London, Ontario, Canada

Correspondence Address:
Ayman Krayem
King Khalid National Guard Hospital, Intensive Care Unit, P.O. Box 9515, Jeddah 21423
Saudi Arabia
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DOI: 10.4103/1817-1737.27105

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PURPOSE: To determine the incidence and factors associated with unplanned extubation (UE) in the intensive care unit (ICU) and its relationship with nursing workload. MATERIALS AND METHODS: A retrospective case-control study was carried out within a cohort of ventilated patients in two teaching hospital medical-surgical ICUs. A total of 50 adult patients with UE were studied. Controls were subjects without UE who were matched to the cases on the following Five factors: age, gender, admission diagnostic category, admission date (within 3 months) and duration of mechanical ventilation. Other data including patient demographics, comorbid conditions, APACHE III score, ventilation parameters, use of sedation, re-intubation, mortality rate and ICU/hospital length of stay were collected. Nine equivalents of nursing manpower use score (NEMS) and multiple organ dysfunction score (MODS) were calculated in both, cases and controls, 24 h before and after the event. RESULTS: Sixty-eight episodes of UE occurred in 66 patients during the 24-month study period (1.1%). Patients with UE were more agitated ( P <0.001) and required higher doses of benzodiazepines ( P =0.023) than their controls. UE was associated with a higher rate of re-intubation compared to the control group ( P <0.001) but was not associated with a longer length of stay in ICU or hospital or excess mortality ( P >0.05). The mean NEMS were not significantly different between the two groups 24 h before ( P =0.69) and after ( P =0.99) the extubation event. Also, the mean MODS were similar between both groups 24 h before ( P =0.69) and after ( P =0.74) extubation. CONCLUSION: In this study, agitation and greater use of benzodiazepines were frequently associated with UE and potentially can be used as risk factors for UE. We have found no significant impact of UE on increasing mortality and, in a manner not shown before, nursing workload.


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