A retrospective analysis of the incidence and determinants of self-extubation in a tertiary care surgical intensive care unit

Abstract

Background & Objective: Self-extubation is reported as one of the most common adverse events in the adult
intensive care units worldwide. We aimed to find out the incidence and determinants of self-extubation in surgical intensive care unit of our tertiary care hospital.
Methodology: It was retrospective analysis of the data acquired from the hospital databases, about the patients who self-extubated during admission to surgical intensive care unit (SICU) of Aga Khan University Hospital, Karachi, Pakistan, during six calendar years, from January 01, 2010, through December 31, 2016. Data collection form was used to collect personal details, drugs used for sedation, sedation agitation score, pain score, nurse-patient ratio and the use of any restraint at the time of extubation. SPSS was used to analyze data applying the central limit theorem to calculate the mean and standard deviation for quantitative variables and the Chi-square test was conducted using a P < 0.05 for qualitative variables. Multivariate logistic regression analysis was performed to identify the independent risk factors for self-extubation
Results: A total of 618 patients were admitted to the SICU who required mechanical ventilation during the study period. An overall 2.1% incidence of self-extubation was calculated with a documented thirteen self-extubation episodes. The mean age of patients was 38.46 ± 16.97 y with majority of them being males. Most, 9 (69.2%), of the patients were not restrained at the time of self-extubation. Nurse to patient ratio was 1:1. Majority of patients 7 (53.8%) were not on any sedative drug infusion and the mean sedation agitation score at that time was 4.46 ± 2.02 while mean pain score was 5.31 ± 2.72. Reintubation was performed in 10 (76.9%) of the patients, who had self-extubated.
Conclusion: This study revealed that the incidence of self-extubation was 2.1% in SICU and there was strong
correlation between absent physical restraint and self-extubation incidence during the weaning period.
Key words: Mechanical ventilation; Reintubation; Self-extubation; Sedation; Surgical Intensive Care Unit; Tertiary Care Hospital Ali MA, Rashid S, Siddiqui KM, Yousuf MS. A retrospective analysis of the incidence and determinants of self-extubation in a tertiary care surgical intensive care unit. Anaesth. pain intensive care 2023;27(3):260−263; DOI: 10.35975/apic.v27i3.2231
Received: October 03, 2022; Reviewed: April 04, 2023; Accepted: April 19, 2023