2012 OPEN FORUM Abstracts
PREDICTING RE-INTUBATION IN PATIENTS WHO SELF EXTUBATIONS IN THE ICU.
Kenneth Miller, Robert Leshko, Michael Weiss; Lehigh Valley Health Network, Bath, PA
Introduction: In an effort to improve quality and safety in ICUs, general and specific outcomes from mechanical ventilation should be known. One outcome that should be assessed is the number of planned or unplanned extubations, thus self-extubations (SE). Predicting which patients will require early re-intubation may lead to lower SE related complications. This abstract report the characteristics and outcomes of patients who experience SE and describes predictors of patients who may benefit from early reintubation after SE. Study Design: We conducted a retrospective comparative study to describe SE at our institution and to determine predictors of re-intubation. Our Institutional Review Board deemed this study exempt. Results: Calendar years 2008 and 2009 there were 6,288 mechanically ventilated patients at our institution. There were 169 episodes of SE comprising 2.8% of patients mechanically ventilated. There were 5,167 physician ordered extubations during this same period. The remaining 1,121 ventilated patients either expired or were discharged home or to another facility while dependent on the ventilator. Nine episodes of SE were lacking documentation on the need for re-intubation, they were excluded from all analyses. Gender, age and BMI were all similar. There was a difference noted in the mean ventilator day between ordered and self-extubations, 3.3 and 3.9 days respectively (p=.032). BMI data was missing for 311 patients in the ordered extubation group. We imposed the mean on these patients. Demographics and baseline characteristics of patients who required re-intubation within 24 hours after their episode of SE (n=46) as compared to those who successfully liberated themselves (n=114). There was no difference between the groups in gender, age or BMI. The duration of necessity for mechanical ventilation was different between the two groups. Those who were successfully liberated had a significantly lower mean ventilator duration than those who required re-intubation, 3.3 versus 5.6 days (p=.005). There was no difference seen between level of sedation, method of sedation, sedation agitation scale score, time of day (7pm-7am) or the use of BiPAP post SE. (Table 1) Conclusion: Patients who self-extubate who are on the ventilator greater than five days and are receiving greater ventilator support have a higher incidence of re-intubation. Other clinical interventions or patient characteristics have little impact on re-intubation. Sponsored Research - None Table 1