Abstract
Background: Self-extubation can occur in patients on mechanical ventilation in ICU. This study aimed to evaluate the frequency of self-extubation, the reintubation rate after self-extubation, the clinical characteristics of patients that undergo reintubation after self-extubation, and the prognosis of patients that experience self-extubation at our ICU. Methods: We retrospectively evaluated incident reports and ICU data that were prospectively collected between April 2013 and March 2015. Results: A total of 590 patients required mechanical ventilation. Of these, 41 patients (7%) experienced self-extubation. We selected 33 patients for our study after excluding 8 patients with missing data. Sixteen patients (48%) required reintubation, whereas 17 patients (52%) did not. The patients were reintubated more often after self-extubation (16 of 33) than after planned extubation. Chronic heart failure and a requirement for noradrenaline were found to be risk factors for reintubation after self-extubation (50% vs. 12% and 56% vs. 18%, respectively; both P<0.05). The patients who required reintubation experienced significantly longer ICU stays and a higher complications rate than those who not did require reintubation (20±14 vs. 10±5 days and 5 vs. 0, respectively; both P<0.05). All deaths involved patients that underwent reintubation. Conclusions: Patients with unstable hemodynamics, for example, those with chronic heart failure or that require noradrenaline, are at high risk of reintubation after self-extubation. Reintubation after self-extubation is associated with a significantly longer ICU stay and a tendency towards a higher complications rate. Physicians should manage patients with unstable hemodynamics carefully.
