Prospective multi-center evaluation of the incidence of unplanned extubation and its outcomes in French intensive care units. The Safe-ICU study.

Accidental extubation Critical care Extubation Extubation failure Mechanical ventilation Self-Extubation Unplanned extubation

Journal

Anaesthesia, critical care & pain medicine
ISSN: 2352-5568
Titre abrégé: Anaesth Crit Care Pain Med
Pays: France
ID NLM: 101652401

Informations de publication

Date de publication:
30 Jul 2024
Historique:
received: 06 05 2024
revised: 01 07 2024
accepted: 15 07 2024
medline: 2 8 2024
pubmed: 2 8 2024
entrez: 1 8 2024
Statut: aheadofprint

Résumé

We aimed to determine the epidemiology and outcomes of unplanned extubation (UE), both accidental and self-extubation, in ICU. 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. 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 PaO 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.

Sections du résumé

BACKGROUND BACKGROUND
We aimed to determine the epidemiology and outcomes of unplanned extubation (UE), both accidental and self-extubation, in ICU.
METHODS 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 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 PaO
CONCLUSION 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.

Identifiants

DOI: 10.1016/j.accpm.2024.101411 PMID: 39089458
pubmed: 39089458
pii: S2352-5568(24)00069-9
doi: 10.1016/j.accpm.2024.101411
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

101411

Informations de copyright

Copyright © 2024. Published by Elsevier Masson SAS.

Auteurs

Jérémie Guillemin (J)

Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.

Benjamin Rieu (B)

Université Clermont Auvergne, NeuroDOL, INSERM, Department of Anesthesiology and Critical Care, Clermont-Ferrand University Hospitals, Clermont-Ferrand, France.

Olivier Huet (O)

University of Bretagne Occidentale, Department of Anesthesiology and Critical Care, Brest University Hospitals, Brest, France.

Léonie Villeret (L)

Surgical ICU, Department of Anesthesiology and Critical Care Medicine, University Hospital of Amiens Picardy, Amiens, France.

Stéphanie Pons (S)

Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.

Anne Bignon (A)

Surgical Critical Care, Department of Anesthesia Critical Care & Perioperative Medicine, Lille University Hospitals, Lille, France.

Quentin de Roux (Q)

University of Paris, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor University Hospital, Créteil, France.

Raphaël Cinotti (R)

CHU Nantes, Nantes Université, Department of Anaesthesia and critical care, Hôtel Dieu, F-44000, Nantes, France; UMR 1246 SPHERE "MethodS in Patients-centered outcomes and HEalth Research", University of Nantes, University of Tours, INSERM, IRS2 22 Boulevard Benoni Goulin, 44200, Nantes, France.

Vincent Legros (V)

Department of Anesthesiology and Critical Care, Reims University Hospital, Reims, France.

Gaëtan Plantefeve (G)

Intensive Care Unit, Victor Dupouy Hospital, Argenteuil, France.

Claire Dayhot-Fizelier (C)

Service d'Anesthésie-Réanimation-Médecine Péri-Opératoire, INSERM U1070, Pharmacologie des antiinfectieux, CHU de Poitiers, 86000 Poitiers, France.

Edris Omar (E)

Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.

Cyril Cadoz (C)

Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France.

Fanny Bounes (F)

Anesthesiology & Critical Care Medicine, Toulouse University Hospital, Toulouse, France.

Cécile Caplin (C)

Intensive Care Unit, Simone Veil Hospital, Beauvais, France.

Karim Toumert (K)

Multidisciplinary Intensive Care Unit, APHP Paris Saclay University, Antoine Béclère Hospital, Clamart, France.

Thibault Martinez (T)

Federation of anesthesiology, intensive care unit, burns and operating theater, Percy Military Training Hospital, Clamart, France.

Damien Bouvier (D)

Neuro-Intensive Care Unit, Rothschild Foundation Hospital, 29, Rue Manin, 75940 Paris Cedex 19, France.

Maxime Coutrot (M)

Department of Anaesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris 75010, France; FHU Promice, Paris, France.

Thomas Godet (T)

Université Clermont Auvergne, NeuroDOL, INSERM, Department of Anesthesiology and Critical Care, Clermont-Ferrand University Hospitals, Clermont-Ferrand, France.

Pierre Garçon (P)

Medical and Surgical Intensive Care Unit, Grand Hôpital de l'Est Francilien site Marne-la-Vallée, Jossigny, France.

Jean-Michel Constantin (JM)

Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France. Electronic address: jean-michel.constantin@aphp.fr.

Mona Assefi (M)

Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.

Florian Blanchard (F)

Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.

Classifications MeSH