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Factors Predicting Self-Extubation
Description
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A5152 - Factors Predicting Self-Extubation
Author Block: M. Siddiqi, Y. I. Lee; Pulmonary, Critical Care, Sleep Medicine, Mount Sinai Beth Israel, New York, NY, United States.
Rationale
The purpose of this study is to identify factors associated with self-extubation and outcomes. We hypothesize that the majority of these events will occur during off-hours or around hand-off times, during spontaneous breathing trials (SBT), and/or over the weekend.
Methods
We prospectively collected information using a self-extubation evaluation form in a 16-bed closed medical intensive care unit (MICU) from April 2017 to October 2017. Data collected included patient’s age and sex, reason for intubation, duration of intubation, day of week and time of self-extubation, physical distance of the patient’s room from the nursing station, use of physical restraints, use of sedation, ventilator mode and settings, endotracheal tube (ETT) size and placement at lip line, whether the ETT was secured or not, Richmond Agitation and Sedation Score (RASS), history of difficult sedation (alcohol abuse, opioid abuse, or chronic benzodiazepine use), and outcomes (required reintubation or remained extubated, with or without the need for non-invasive positive pressure ventilation (NIPPV)). All data was recorded into a secure database.
Results
To date we have collected information for 7 patients with ongoing data collection. On preliminary analysis we have not identified any clear associations due to the small sample size. We found the majority of self-extubations (85.7%) occurred during the workday and within an hour of staff change-over times. Only one patient (14.3%) was on an SBT with pressure support (PS) during the time of self-extubation, the rest were on assist control (AC). All patients had some form of restraint and 6 (85.7%) were on sedation with at least an opioid; of those 6 on an opioid, 4 (66.7%) were on another agent including either a benzodiazepine, propofol, or dexmedetomidine. Of note, all patients remained extubated of which 2 of the 7 (28.6%) required NIPPV.
Conclusion
While a larger sample size is needed to delineate statistically significant factors associated with self-extubation, our initial data so far does not support our hypothesis that most self-extubations will occur during SBT.
Author Block: M. Siddiqi, Y. I. Lee; Pulmonary, Critical Care, Sleep Medicine, Mount Sinai Beth Israel, New York, NY, United States.
Rationale
The purpose of this study is to identify factors associated with self-extubation and outcomes. We hypothesize that the majority of these events will occur during off-hours or around hand-off times, during spontaneous breathing trials (SBT), and/or over the weekend.
Methods
We prospectively collected information using a self-extubation evaluation form in a 16-bed closed medical intensive care unit (MICU) from April 2017 to October 2017. Data collected included patient’s age and sex, reason for intubation, duration of intubation, day of week and time of self-extubation, physical distance of the patient’s room from the nursing station, use of physical restraints, use of sedation, ventilator mode and settings, endotracheal tube (ETT) size and placement at lip line, whether the ETT was secured or not, Richmond Agitation and Sedation Score (RASS), history of difficult sedation (alcohol abuse, opioid abuse, or chronic benzodiazepine use), and outcomes (required reintubation or remained extubated, with or without the need for non-invasive positive pressure ventilation (NIPPV)). All data was recorded into a secure database.
Results
To date we have collected information for 7 patients with ongoing data collection. On preliminary analysis we have not identified any clear associations due to the small sample size. We found the majority of self-extubations (85.7%) occurred during the workday and within an hour of staff change-over times. Only one patient (14.3%) was on an SBT with pressure support (PS) during the time of self-extubation, the rest were on assist control (AC). All patients had some form of restraint and 6 (85.7%) were on sedation with at least an opioid; of those 6 on an opioid, 4 (66.7%) were on another agent including either a benzodiazepine, propofol, or dexmedetomidine. Of note, all patients remained extubated of which 2 of the 7 (28.6%) required NIPPV.
Conclusion
While a larger sample size is needed to delineate statistically significant factors associated with self-extubation, our initial data so far does not support our hypothesis that most self-extubations will occur during SBT.
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