Planned Versus Unplanned Extubation in Opioid Overdose Patients: Does it Have any Effect on the Prognosis? A Cohort Study

Background: Tracheal intubation is a life-saving measure in patients poisoned acutely with opioid, and when naloxone treatment is inadequate. This study determined the risk factors for early unplanned extubation in these patients and evaluated the effects on the clinical outcomes. Methods: At a poisoning center in Tehran, Iran, 165 opioid overdose patients who were admitted to the intensive care unit and intubated between September 2019 and March 2020 were enrolled into this study. Patients were categorized in two groups: a) those extubated based on the physicians’ decision, and b) those who were extubated by self or were accidentally. The two groups were compared regarding their clinical outcomes and complications during hospitalization. In addition, the re-intubated patients in both groups were compared to those with successful intubation regarding the predisposing factors and mortality. Results: Of these patients, 36 (21.8%) died before extubation, and planned extubation was performed in 109 of them (84.5%). Unplanned extubation occurred in 20 patients (15.5%). Agitation, elevated temperature (>38.5ºC), and insufficient nursing care were the independent risk factors for the unplanned extubation. 6(5.5%) and 3(15%) patients died following the planned and unplanned extubation, respectively, and 24 patients required reintubation. Patient transfer, succinylcholine use, aspiration pneumonia, presence of brain injury, and insufficient nursing care were independent risk factors for re-intubation. Conclusion: Among the patients with high drug dependency, higher doses of sedatives were needed to avoid self-extubation. Infection control and sufficient nursing care were factors that led to better clinical outcomes for extubation in these patients.