Piriyapatsom Annop, Chittawatanarat Kaweesak, Kongsayreepong Suneerat, Chaiwat Onuma
J Med Assoc Thai. 2016 Sep;99 Suppl 6:S153-S162.
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.
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.
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.
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.
非计划拔管（UE）是需要气管插管和机械通气的重症患者最棘手的事件之一。本研究旨在确定泰国重症外科患者中UE的发生率，并识别与之相关的风险因素。
这是一项多中心前瞻性观察队列研究，纳入了2011年4月至2013年1月期间泰国9家大学附属医院外科重症监护病房（SICU）收治的手术患者。UE定义为患者自行拔管（自我拔管）或在操作或转运过程中意外拔管。计算UE的发生率，采用校正逻辑回归模型确定UE的独立危险因素，并比较计划拔管患者和UE患者的结局。
2890例需要气管插管和机械通气的患者纳入分析。其中，54例发生UE，因此UE的发生率为1.9%。确定了5个UE的独立危险因素；充血性心力衰竭（校正比值比，OR，3.48；95%可信区间，1.29-9.40）、急诊手术（校正OR，2.18；95%可信区间，1.01-4.74）、非术后状态（校正OR，2.37；95%可信区间，1.05-5.37）、使用镇静剂（校正OR，3.19；95%可信区间，1.72-5.93）和谵妄（校正OR，3.61；95%可信区间，1.71-7.60）。UE患者的重症监护病房住院时间（LOS）显著长于计划拔管患者（校正系数，2.76；95%可信区间，1.34-4.19）。两组在住院LOS、重症监护病房及28天死亡率方面无显著差异。
重症外科患者中UE的发生率为1.9%。UE的5个独立危险因素为：潜在的充血性心力衰竭、急诊手术、非术后状态、使用镇静剂和谵妄。UE患者的重症监护病房LOS显著长于计划拔管患者。
