Vassal T, Anh N G, Gabillet J M, Guidet B, Staikowsky F, Offenstadt G
Service de Réanimation Polyvalente, Hôpital Saint-Antoine, Paris, France.
Intensive Care Med. 1993;19(6):340-2. doi: 10.1007/BF01694708.
To evaluate the incidence, associated factors and gravity of self-extubations.
Prospective study about all patients intubated over an 8 month period.
A medical intensive care unit of a University Hospital.
Patients were divided into two groups: self-extubated and those that did not. The self-extubations were separated into deliberate acts by the patients and accidental.
24 of the 197 patients included presented a total of 27 extubations (12%). There were 21 deliberate incidents and 6 accidental. The only differences between the cases and the rest of the population were a higher mean age (67 vs 59 years) and a larger proportion of chronic respiratory failure (66% versus 35%). Reintubation was necessary in 20 cases (74%) within 30 min in 16 cases. The main indication for reintubation was acute respiratory distress (90%). Reintubation was associated with one death.
Self-extubation is a frequent and serious complication of mechanical ventilation. Deliberate self-extubation, the most frequent type of incident could possibly be reduced by better sedation of agitated patients and accidental self-extubation by better training of the nursing staff.
评估自行拔管的发生率、相关因素及严重程度。
对8个月期间所有接受插管的患者进行前瞻性研究。
一所大学医院的医学重症监护病房。
患者分为两组：自行拔管组和未自行拔管组。自行拔管又分为患者的故意行为和意外情况。
197例患者中有24例共发生27次拔管（12%）。其中21次为故意事件，6次为意外。病例组与其他患者的唯一差异是平均年龄较高（67岁对59岁）以及慢性呼吸衰竭比例较高（66%对35%）。20例（74%）患者在30分钟内需要重新插管，16例在30分钟内重新插管。重新插管的主要指征是急性呼吸窘迫（90%）。重新插管导致1例死亡。
自行拔管是机械通气常见且严重的并发症。对于躁动患者更好的镇静可能会减少最常见的故意自行拔管事件，而对护理人员更好的培训可能会减少意外自行拔管事件。
