Kapadia F N, Bajan K B, Raje K V
Hinduja National Hospital and Medical Research Center, Mumbai, India.
Crit Care Med. 2000 Mar;28(3):659-64. doi: 10.1097/00003246-200003000-00010.
To assess the rate of occurrence and nature of airway accidents in intubated patients.
Prospective recording of all airway accidents in a 16-bed multidisciplinary intensive care unit.
A total of 5,046 ventilated patients intubated for 9,289 days during 4 yrs.
We determined the number and diagnoses of intubated and ventilated patients, the number and timing of airway accidents, the type of tracheal tube used and duration for which the tube was in situ, the description of the type of accident, the severity of the accident, and its impact on the course of the patient's illness, whether the patient needed reintubation, and whether the accident was preventable. The total accident rate was 36 of 5,046 patients during 9,289 intubated patient days; 26 occurred in 5,043 endotracheally intubated patients during 8,446 patient endotracheal tube days. There were 10 tracheostomy-related accidents from a total of 79 patients with tracheostomies during 843 tracheostomy patient days. Six had severe consequences and one resulted in death. Eleven were completely preventable, 17 partly preventable, and 8 were considered unpreventable. Self-extubation was the most common accident. Seven of 13 self extubations occurred in patients due for elective extubation in the next few hours. Twelve of 15 patients with self- or accidental extubation of an endotracheal tube accidents did not require reintubation.
Airway accidents occurred at low levels with even lower rates of resultant morbidity and mortality. Tracheostomy accidents are more common than those with an endotracheal tube.
评估插管患者气道意外的发生率及性质。
在一个拥有16张床位的多学科重症监护病房对所有气道意外进行前瞻性记录。
4年间共有5046例患者接受机械通气插管，累计9289天。
我们确定了插管及机械通气患者的数量和诊断情况、气道意外的数量及发生时间、所使用气管导管的类型及导管留置时间、意外类型描述、意外严重程度及其对患者病程的影响、患者是否需要再次插管以及意外是否可预防。在9289个插管患者日期间，5046例患者中发生意外共36起；在8446个气管插管患者日期间，5043例经气管插管患者中发生意外26起。在843个气管切开患者日期间，79例气管切开患者中共发生10起与气管切开相关的意外。其中6起造成严重后果，1起导致死亡。11起完全可预防，17起部分可预防，8起被认为不可预防。自行拔管是最常见的意外。13例自行拔管中有7例发生在预计未来数小时内行择期拔管的患者。15例气管插管自行或意外拔管患者中有12例无需再次插管。
气道意外发生率较低，由此导致的发病率和死亡率更低。气管切开意外比气管插管意外更常见。
