UNPLANNED EXTUBATION IN MEDICAL ICU

Objective: To investigate incidence, clinical characteristics, and outcomes of unplanned extubation (UE) in medical intensive care unit in King Chulalongkorn Memorial Hospital during June 1st, 2002 to January 31 st , 2003. Research Design: A descriptive study. Methods: All intubated medical ICU patients who underwent unplanned removal of endotracheal tube was enrolled to this study. Clinical characteristics, sedation scores to evaluate sedation adequacy and outcomes of unplanned extubation were collected. Results: 471 patients were intubated in medical ICU during an eight-month study. 23 unplanned extubations (4.9%) in 21 patients have been documented. The majority of unplanned extubated cases (16 of 23, 69.6 %) occurred in the first 48 hours after intubations. There was no significant difference in extubations between shifts of work of medical personnel. The motor activity assessment scales (MAAS) were equal to 4 to 6 (cRestless and Cooperativee to cDangerously Agitatede) in the majority (17 of 23, 73.9 %) of UE, however, only one (5.9%) of them was sedated, and nine (58.8%) of them were restrained. The ventilation assessment scales (VAS) were from A to B (cComfortablee to cMildly Distresse) in most (21 of 23, 91.3%) of self-extubated patients. Reintubations were required in 12 episodes (52.2 %), mostly in 1 hour after extubation. There was no serious adverse event attributed to unplanned extubation. No significant difference in age, gender distribution, diagnosis, and duration of intubation between the reintubated and non-reintubated group was observed. Of the respiratory support modes and parameters studied, the mean pre-extubation ventilator-delivered minute ventilation