The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

InadvertentExtubation Rates in a Tertiary Care Medical Center

MichaelH. Terry RCP RRT, Thomas P. Malinowski RCP RRT, Loma Linda University MedicalCenter and Children?s Hospital, Loma Linda, California, 92354

Purpose: Inadvertent airwayextubation (IE) is a hazard for intubated patients requiring mechanical ventilation,and has the potential for increased morbidity or mortality. We sought to betterunderstand our incidence of IE, compare our rates to the rate of accidentalextubation with previously published studies, and understand the consequenceof IE in multiple ICU populations.

Design: Prospective recordingby 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 CardiothoracicCare (CTICU), Surgical Intensive Care (SICU), Medical Intensive Care (MICU),and a Community Hospital Intensive Care (CMCICU). The primary outcome measuresincluded 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 indexedto 100 ventilator days:

Intensive Care Unit Total number of IEsNumber of Ventilator DaysAvg. IE rate per 100 vent.Days (SD)Reintubation within 24 hours(%) 2/1997- 1/2000
NICU211 30,7600.69 (0.38) 31/56 (55%)
PICU12619,329 0.65 (0.46)10/40 (25%)
CCU133,140 0.41 (0.39)1/3 (33%)
CTICU504,1471.21 (1.9)5/8 (63%)
SICU9113,2260.69 (0.48)7/22 (32%)
MICU6814,0720.48 (0.42)10/25 (40%)
CMCICU223,4320.64 (0.57)2/2 (100%)
Sedation relatedand procedure related IE?s were most common in the NICU and PICU. Motion or restraintrelated IE?s were observed in all ICU?s.

Discussion: IE is an eventthat occurs in all intensive care units. Our data does not demonstrate a higherpreponderance of IE in the infant and child population, contrary to previouslypublished reports. The overall incidence is comparable to previously publisheddata. We are now focusing our interest on unit specific causal and outcome trends.


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