Chest
Clinical Investigations in Critical CareCharacteristics and Outcomes of Patients Who Self-Extubate From Ventilatory Support: A Case-Control Study
Section snippets
Setting and Sample
The study took place at the Cleveland Clinic Foundation, a 1,000-bed national referral center. Cleveland Clinic Foundation has nine adult ICUs (n = 100 beds) with >3,000 patients a year receiving mechanical ventilation.
The cases consisted of all adult patients with occurrences of purposeful SE from mechanical ventilation who were reported by nursing staff to the nursing quality management office during 1993. We defined SE as purposeful patient removal of the ET as witnessed by the nursing
RESULTS
One hundred fifty patients comprised the study sample; 50 who were SE each matched to two patients who were NSE. Results from the univariate analyses are displayed in Table 2, Table 3, Table 4. Table 2 displays the hospital variables for each group. Marginally more of the NSE group returned to home, had a lower rate of discharge to a long-term care setting, and a lower rate of death compared to those in the SE group. Significantly more of the NSE group had a surgical procedure (75%; vs 48%;,
DISCUSSION
SE from mechanical ventilation is a major concern for health-care professionals in the care of ventilated patients. Only a few studies have examined patient factors associated with outcomes of SE.1,5 This retrospective case-control study was conducted to further extend previous work in this area. We found that cases compared to control patients were more often restless or agitated and had more hospital-acquired complications. Furthermore, 25%; of the SE patients did not require reintubation,
Reference (21)
- et al.
Self-extubations: a 12-month experience
Chest
(1990) - et al.
Acute complications of endotracheal intubation: relationship to reintubation, route, urgency, and duration
Chest
(1986) - et al.
Complications and consequences of endotracheal intubation and tracheotomy: a prospective study of 150 critically ill adult patients
Am J Med
(1981) - et al.
Unplanned extubations
Chest
(1994) - et al.
Unplanned extubation: predictors of successful termination of mechanical ventilatory support
Chest
(1994) - et al.
Complications of assisted ventilation: a prospective study of 354 consecutive episodes
Am J Med
(1974) The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients
Am J Med
(1994)- et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Self-extubation
Chest
(1991) - et al.
Decreasing unplanned extubations in the surgical intensive care unit
Am J Surg
(1995)
Cited by (105)
Factors associated with unplanned extubation in the Intensive Care Unit for adult patients: A systematic review and meta-analysis
2018, Intensive and Critical Care NursingCitation Excerpt :For the case control studies, the participants of the no UE group in three of the studies were randomly selected, others were according to case matching. In all the case matching studies, all of them (Chang et al., 2011; Tung et al., 2001; Chang et al., 2008; Atkins et al., 1997) matched cases and controls on basis of gender, age and dates in hospitals, while three of them matched cases and controls on basis of diagnosis (Chang et al., 2011; Tung et al., 2001; Chang et al., 2008), therefore, these studies were taken out of the analysis to assess the impact of these factors on the risk for UE. And for the cohort studies, all the patients were included during the study period.
Analgesics, tranquilizers, and sedatives
2018, Cardiac Intensive CareManagement of Sedation and Paralysis
2016, Clinics in Chest MedicineRevisiting endotracheal self-extubation in the surgical and trauma intensive care unit: Are they all fine?
2015, Journal of Critical CareRelationship between delirium and ventilatory outcomes in the medical intensive care unit
2020, Critical Care NurseCitation Excerpt :Unplanned extubation includes both self-extubation by the patient (intentional or unintentional) and accidental extubation that may occur with patient care activities. Regardless of the cause, unplanned extubation can result in multiple complications, including airway trauma, aspiration pneumonia, respiratory arrest, and reintubation.16 These complications often result in longer hospital stays, increased duration of mechanical ventilation, increased incidence of infections, higher costs, and greater mortality.17,18
Presented in part at the 1996 annual meetings of the American Geriatrics Society/American Federation of Aging Research, Chicago
Reprint requests: Lorraine Mion, PhD, RN, Dept of Nursing Research, P32, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195