Assessing the need for reintubation: A prospective evaluation of unplanned endotracheal extubation

Objective: Unplanned endotracheal extubation (UEE) is a common complication in medical intensive care units but very little data about UEE in surgical populations are available. Our hypothesis is that the surgical intensive care unit (SICU) population requires reintubation less frequently compared with the medical intensive care unit population. We prospectively gathered data on patients in a SICU in an attempt to identify the incidence of UEE and to study the need for reintubation after UEE. Methods: During an 18-month period, we prospectively identified SICU patients from a quality improvement database who required ventilatory support. All patients who self- extubated were included in the study. Results: Fifty-eight of 1,178 intubated patients experienced unplanned extubation 61 times during the 18-month period. A total of 22 patients (36%) required reintubation, whereas 39 patients (64%) did not. Thirty-three patients self-extubated while being actively weaned from ventilatory support. Of these, only 5 patients (15%) required reintubation and 28 patients (85%) did not (p < 0.01). Conclusion: A total of 85% of patients who self-extubate during the weaning process did not require reintubation in our study. Those who have an FIO₂ >50%, a lower PaO₂/FIO₂ ratio, had UEE occur by accident, or were not being weaned when UEE occurred required reintubation more frequently. These data suggest that some of our SICU patients are intubated longer than necessary, which may translate into more ventilator related complications, longer ICU stays and increased cost.