2000 OPEN FORUM Abstracts
EXAMINING THE CONSEQUENCES OF SELF-EXTUBATION
John M. Welton RN, MSN and Daniel G. Gassaway BS, RRT, University of North Carolina Hospital's, Chapel Hill, North Carolina
Background: Introduction of a temporary endotracheal tube for pulmonary support in the intensive care unit is complicated by the risk of premature removal of the tube. Extubation under uncontrolled circumstances jeopardizes the patient's cardiorespiratory status and may result in death. In an effort to quantify the scope of this problem, we gathered data over an 18 month period.
Methods: Concurrent and retrospective data were collected by staff nurses and clinical nurse supervisors for each unplanned extubation in six adult intensive care units of a major teaching medical center.
Results: A mean of 13.28 (SD 5.29) self-extubations per 1000 ventilator days occurred each month. Of these events, 51% were routinely reintubated, 48% remained extubated and less than 1% were reintubated with complications. Conclusion: Unplanned extubation is a common problem in the ICU that is usually well tolerated by the patient. These results suggest that many patients may be ventilated unnecessarily, emphasizing the need for expedient weaning and termination of ventilator support when warranted.