The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

THE COMPARISON BETWEEN UNPLANNED EXTUBATION AND PLANNED EXTUBATION—THE PROGNOSIS AND THE THE PREDICTOR.

Chin-Ming Chen1, Ai-Ching Cheng2, Shu-Chen Hsing2, Mei-Yi Sung2; 1Intensive care medicine, Chi-Mei Medical center, Tainan, Taiwan; 2Respiratory care, Chi-Mei Medical center, Tainan, Taiwan

Background: We want to investigate the prognosis and predictors of patients with endotracheal intubation experiencing unplanned extubation (UE) as compared with planned extubation (PE) in the adult intensive care units (ICUs) of a medical center in Taiwan. Methods:We retrospectively reviewed the medical records of ICU patients with UE and PE in 2010, including the demographic data, clinical variables and the latest data before extubation. Results:There were 3092 patients received ventilator support via endotracheal tube in 2010, including 58 patients with UE (1.85%) and 1736 patients with PE (56.14%). Those patients with UE had higher hospital mortality (22.4% vs.6.7%), longer ICU and hospital stays (11.4 vs.7.0 and 32.7 vs. 21.9 days, respectively) and higher hospital costs (10.8 vs. 8.5 x 1000 US Dollars). The successful rate of liberation from ventilator (not re-intubation within 48 hours) was also lower in UE group (63.1% vs. 96.1%). In multivariate analyses, the factors predicting UE (as compared with PE) were lower coma scales [odds ratio (OR), 0.932], histories of coronary arterial disease(CAD) (OR, 2.399) and cardiovascular accident (CVA) (OR, 2.983), higher respiratory rate (OR, 1.134), tidal volume (OR, 1.004) and positive end-expiratory pressure (PEEP) (OR,2.660) before extubation, higher creatinine level (OR,1.166), pre-extubation agitation (OR,6.007) and sedation use (OR,45.5). Conclusions: We found that those with UE had a poor prognosis in hospital mortality, length of stay, cost and rate of ventilator liberation. Many factors predicted UE, including lower coma scales, histories of CAD and CVA, higher respiratory rate, tidal volume and PEEP before extubation, higher creatinine level, agitation and sedation use. Physicians should provide a safety care on those patients with ventilator support, and consider the risk factors of UE and adverse events after UE. Sponsored Research - None The outcome of the different UE groups Expressed as mean ± SD (range) or n (%) * presented as not re-intubation within 48 hours from ventilator weaning