Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.
Université Clermont Auvergne, NeuroDOL, INSERM, Department of Anesthesiology and Critical Care, Clermont-Ferrand University Hospitals, Clermont-Ferrand, France.
Anaesth Crit Care Pain Med. 2024 Oct;43(5):101411. doi: 10.1016/j.accpm.2024.101411. Epub 2024 Jul 30.
We aimed to determine the epidemiology and outcomes of unplanned extubation (UE), both accidental and self-extubation, in ICU.
A multicentre prospective cohort study was conducted in 47 French ICUs. The number of mechanical ventilation (MV) days, and planned and unplanned extubation were recorded in each center over a minimum period of three consecutive months to evaluate UE incidence. Patient characteristics, UE environmental factors, and outcomes were compared based on the UE mechanism (accidental or self-extubation). Self-extubation outcomes were compared with planned extubation using a propensity-matched population. Finally, risk factors for extubation failure (re-intubation before day 7) were determined following self-extubation.
During the 12-month inclusion period, we found a pooled UE incidence of 1.0 per 100 MV days. UE accounted for 9% of all endotracheal removals. Of the 605 UE, 88% were self-extubation and 12% were accidental-extubations. The latter had a worse prognosis than self-extubation (34% vs. 8% ICU-mortality, p < 0.001). Self-extubation did not increase mortality compared with planned extubation (8% vs. 11%, p = 0.075). Regardless of the type of extubation, planned or unplanned, extubation failure was independently associated with a poor outcome. Cancer, higher respiratory rate, lower PaO/FiO at the time of extubation, weaning process not-ongoing, and immediate post-extubation respiratory failure were independent predictors of failed self-extubation.
Unplanned extubation, mostly represented by self-extubation, is common in ICU and accounts for 9% of all endotracheal extubations. While accidental extubations are a serious and infrequent adverse event, self-extubation does not increase mortality compared to planned extubation.
本研究旨在确定 ICU 中非计划性拔管（UE），包括意外拔管和患者自行拔管的流行病学和结局。
这是一项多中心前瞻性队列研究，在法国 47 家 ICU 中进行。在每个中心记录机械通气（MV）天数、计划拔管和非计划性拔管的情况，每个中心至少连续 3 个月记录，以评估 UE 的发生率。根据 UE 机制（意外或自行拔管）比较患者特征、UE 环境因素和结局。使用倾向评分匹配人群比较自行拔管和计划拔管的结局。最后，确定自行拔管后发生拔管失败（第 7 天前重新插管）的危险因素。
在 12 个月的纳入期间，我们发现每 100 MV 天发生 1.0 例 UE。UE 占所有气管内拔管的 9%。在 605 例 UE 中，88%为自行拔管，12%为意外拔管。后者的预后比自行拔管差（34%与 8%的 ICU 死亡率，p<0.001）。与计划拔管相比，自行拔管并未增加死亡率（8%与 11%，p=0.075）。无论拔管类型（计划或非计划），拔管失败均与不良结局独立相关。癌症、更高的呼吸频率、拔管时更低的 PaO/FiO、未进行脱机过程和拔管后立即出现呼吸衰竭是自行拔管失败的独立预测因素。
非计划性拔管，主要由自行拔管引起，在 ICU 中很常见，占所有气管内拔管的 9%。虽然意外拔管是一种严重且罕见的不良事件，但与计划拔管相比，自行拔管并未增加死亡率。
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