背景:我们旨在确定非计划拔管(UE)的流行病学和结果,意外和自拔管,在ICU。
方法:在47个法国ICU中进行了一项多中心前瞻性队列研究。机械通气(MV)天数,在连续3个月的最短时间内,在每个中心记录计划和非计划拔管,以评估UE发生率.患者特征,UE环境因素,根据UE机制(意外或自行拔管)比较结果.使用倾向匹配的人群将自我拔管结果与计划拔管进行比较。最后,自行拔管后确定拔管失败的危险因素(第7天之前再次插管).
结果:在12个月的纳入期内,我们发现合并的UE发生率为每100MV天1.0.UE占所有气管内去除量的9%。在605个UE中,88%为自我拔管,12%为意外拔管。后者的预后比自我拔管更差(34%vs.8%ICU死亡率,p<0.001)。与计划拔管相比,自我拔管并未增加死亡率(8vs.11%,p=0.075)。不管拔管的类型如何,有计划或无计划,拔管失败与不良结局独立相关.癌症,更高的呼吸频率,拔管时降低PaO2/FiO2,断奶过程不进行,拔管后即刻呼吸衰竭是自我拔管失败的独立预测因素。
结论:非计划拔管,主要表现为自我拔管,在ICU中很常见,占所有气管内拔管的9%。虽然意外拔管是一种严重且罕见的不良事件,与计划拔管相比,自我拔管不会增加死亡率.
BACKGROUND: We aimed to determine the epidemiology and outcomes of unplanned extubation (UE), both accidental and self-
extubation, in ICU.
METHODS: A multicentre prospective cohort study was conducted in 47 French ICUs. The number of mechanical ventilation (MV) days, and planned and unplanned extubation were recorded in each center over a minimum period of three consecutive months to evaluate UE incidence. Patient characteristics, UE environmental factors, and outcomes were compared based on the UE mechanism (accidental or self-extubation). Self-
extubation outcomes were compared with planned
extubation using a propensity-matched population. Finally, risk factors for extubation failure (re-intubation before day 7) were determined following self-extubation.
RESULTS: During the 12-month inclusion period, we found a pooled UE incidence of 1.0 per 100 MV days. UE accounted for 9% of all endotracheal removals. Of the 605 UE, 88% were self-extubation and 12% were accidental-extubations. The latter had a worse prognosis than self-extubation (34%vs. 8% ICU-mortality, p < 0.001). Self-
extubation did not increase mortality compared with planned
extubation (8 vs. 11%, p = 0.075). Regardless of the type of extubation, planned or unplanned, extubation failure was independently associated with a poor outcome. Cancer, higher respiratory rate, lower PaO2/FiO2 at the time of extubation, weaning process not-ongoing, and immediate post-
extubation respiratory failure were independent predictors of failed self-
extubation.
CONCLUSIONS: Unplanned
extubation, mostly represented by self-
extubation, is common in ICU and accounts for 9% of all endotracheal extubations. While accidental extubations are a serious and infrequent adverse event, self-extubation does not increase mortality compared to planned extubation.