L. Marcia1, Z. Ashman2, E. Howell2, D. Kim1,2, D. Plurad1,2 1David Geffen School Of Medicine, University Of California At Los Angeles,Los Angeles, CA, USA 2Harbor-UCLA Medical Center,Surgery,Torrance, CALIFORNIA, USA
Introduction: Patient self-extubation can occur in the intensive care unit (ICU). Determining which patients will require reintubation can be challenging. Identification of risk factors for reintubation may facilitate the decision to reintubate.
Objective: Identify predictors for reintubation after patient self-extubation.
Methods: Single institution retrospective analysis of all adult ICU self-extubation events over a two-year period was performed. Patients requiring reintubation within 24 hours were compared to patients that did not using t-test, chi-square test, and bivariate analysis.
Results: Eighty-three patients self-extubated. Sixty-six percent were male, thirty-four percent were female, and the mean age was 54.5 years. Twenty-eight of the 83 patients (34%) required reintubation within 24 hours. Prior to self-extubation, reintubated patients had on average longer hospital length of stay (7.79 days vs 4.65 days, p = 0.0217), longer ICU length of stay (4.86 days vs 3.19 days, p = 0.0295), and more time on the ventilator (4.86 days vs 3.23 days, p = 0.0454). This group required higher levels of FIO2 (49.6% vs 42.2%, p = 0.0116) and breathed at a higher respiratory rate (18.5 vs 16.5, p = 0.0370) prior to self-extubation. No statistically significant differences in other ventilatory parameters were noted. Weaning parameters were obtained in 20 patients (24%), of whom six required reintubation (30%, p = 0.685). There were no statistically significant differences in weaning parameters between the two groups.
Conclusion: It is generally safe to observe patients after a self-extubation episode as most do not require reintubation. Prior to self-extubation, reintubated patients had increased hospital and ICU lengths of stay, and prolonged ventilatory dependence. The reintubation group required higher levels of FIO2 and demonstrated increased respiratory rates prior to self-extubation. There was no association between weaning parameters and later reintubation. Additionally, only 24% of patients were on weaning trials although most patients did not require reintubation. Further study is needed to identify patients who may be appropriate for extubation despite failure of a spontaneous breathing trial or to expand criteria for weaning protocols.