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Inadvertent
Extubation Rates in a Tertiary Care Medical Center
Michael
H. Terry RCP RRT, Thomas P. Malinowski RCP RRT, Loma Linda University Medical
Center and Children?s Hospital, Loma Linda, California, 92354
Purpose: Inadvertent airway
extubation (IE) is a hazard for intubated patients requiring mechanical ventilation,
and has the potential for increased morbidity or mortality. We sought to better
understand our incidence of IE, compare our rates to the rate of accidental
extubation with previously published studies, and understand the consequence
of IE in multiple ICU populations.
Design: Prospective recording
by bedside RCP?s of IE in seven intensive care units for six (6) years (1994
? 2000). The intensive care units are identified as: Neonatal Intensive Care
(NICU), Pediatric Intensive Care (PICU), Coronary Care (CCU), Adult Cardiothoracic
Care (CTICU), Surgical Intensive Care (SICU), Medical Intensive Care (MICU),
and a Community Hospital Intensive Care (CMCICU). The primary outcome measures
included the occurrence of IE (10/94 ? 12/2000), cause of IE (7/96 ? 1/2000),
and outcome of IE (2/97 ? 1/2000).
Results: IE?s are indexed
to 100 ventilator days:
| Intensive Care Unit |
Total number of IEs |
Number of Ventilator Days |
Avg. IE rate per 100 vent.
Days (SD) |
Reintubation within 24 hours
(%)
2/1997- 1/2000 |
| NICU |
211 |
30,760 |
0.69 (0.38) |
31/56 (55%) |
| PICU |
126 |
19,329 |
0.65 (0.46) |
10/40 (25%) |
| CCU |
13 |
3,140 |
0.41 (0.39) |
1/3 (33%) |
| CTICU |
50 |
4,147 |
1.21 (1.9) |
5/8 (63%) |
| SICU |
91 |
13,226 |
0.69 (0.48) |
7/22 (32%) |
| MICU |
68 |
14,072 |
0.48 (0.42) |
10/25 (40%) |
| CMCICU |
22 |
3,432 |
0.64 (0.57) |
2/2 (100%) |
Sedation related
and procedure related IE?s were most common in the NICU and PICU. Motion or restraint
related IE?s were observed in all ICU?s.
Discussion: IE is an event
that occurs in all intensive care units. Our data does not demonstrate a higher
preponderance of IE in the infant and child population, contrary to previously
published reports. The overall incidence is comparable to previously published
data. We are now focusing our interest on unit specific causal and outcome trends.
OF-01-236
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