Prospective multi-center evaluation of the incidence of unplanned extubation and its outcomes in French intensive care units. The Safe-ICU study

IF 3.7 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine Pub Date : 2024-07-30 DOI:10.1016/j.accpm.2024.101411

Jérémie Guillemin , Benjamin Rieu , Olivier Huet , Léonie Villeret , Stéphanie Pons , Anne Bignon , Quentin de Roux , Raphaël Cinotti , Vincent Legros , Gaëtan Plantefeve , Claire Dayhot-Fizelier , Edris Omar , Cyril Cadoz , Fanny Bounes , Cécile Caplin , Karim Toumert , Thibault Martinez , Damien Bouvier , Maxime Coutrot , Thomas Godet , Florian Blanchard

{"title":"Prospective multi-center evaluation of the incidence of unplanned extubation and its outcomes in French intensive care units. The Safe-ICU study","authors":"Jérémie Guillemin , Benjamin Rieu , Olivier Huet , Léonie Villeret , Stéphanie Pons , Anne Bignon , Quentin de Roux , Raphaël Cinotti , Vincent Legros , Gaëtan Plantefeve , Claire Dayhot-Fizelier , Edris Omar , Cyril Cadoz , Fanny Bounes , Cécile Caplin , Karim Toumert , Thibault Martinez , Damien Bouvier , Maxime Coutrot , Thomas Godet , Florian Blanchard","doi":"10.1016/j.accpm.2024.101411","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>We aimed to determine the epidemiology and outcomes of unplanned extubation (UE), both accidental and self-extubation, in ICU.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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% <em>vs.</em> 8% ICU-mortality, <em>p</em> < 0.001). Self-extubation did not increase mortality compared with planned extubation (8% <em>vs.</em> 11%, <em>p</em> = 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<sub>2</sub>/FiO<sub>2</sub> at the time of extubation, weaning process not-ongoing, and immediate post-extubation respiratory failure were independent predictors of failed self-extubation.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101411"},"PeriodicalIF":3.7000,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anaesthesia Critical Care & Pain Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352556824000699","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

We aimed to determine the epidemiology and outcomes of unplanned extubation (UE), both accidental and self-extubation, in ICU.

Methods

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.

Results

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 PaO₂/FiO₂ at the time of extubation, weaning process not-ongoing, and immediate post-extubation respiratory failure were independent predictors of failed self-extubation.

Conclusion

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.

查看原文本刊更多论文

法国重症监护病房意外拔管发生率及其结果的前瞻性多中心评估。安全重症监护室研究。

背景：我们旨在确定重症监护室意外拔管和自行拔管的流行病学和结果：在法国 47 家重症监护室开展了一项多中心前瞻性队列研究。每个中心至少连续三个月记录机械通气（MV）天数、计划内和计划外拔管次数，以评估 UE 发生率。根据 UE 机制（意外拔管或自行拔管）对患者特征、UE 环境因素和结果进行了比较。利用倾向匹配人群对自行拔管与计划拔管的结果进行了比较。最后，确定了自我拔管后拔管失败（第 7 天前再次插管）的风险因素：结果：在为期 12 个月的纳入期内，我们发现每 100 个 MV 天的 UE 发生率为 1.0。UE占所有气管插管拔除率的9%。在 605 例 UE 中，88% 为自行拔管，12% 为意外拔管。后者比自行拔管的预后更差（34%vs.8%的ICU死亡率，拔管时的p 2/FiO2、断奶过程未持续、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）：结论：非计划性拔管（主要表现为自行拔管）在重症监护病房很常见，占所有气管内拔管的 9%。虽然意外拔管是一种严重且不常见的不良事件，但与计划拔管相比，自行拔管不会增加死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Anaesthesia Critical Care & Pain Medicine ANESTHESIOLOGY-

CiteScore

6.70

自引率

5.50%

发文量

150

审稿时长

18 days

期刊介绍： Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.