Unplanned extubations in a level one trauma ICU

Background: Unplanned endotracheal extubation (UE) is the most common airway adverse event in ICU. This study aimed to determine the incidence, characteristics, complications and outcomes of UE in patients in a level one trauma ICU. Methods: A chart review of all patients admitted to the Trauma ICU at Inkosi Albert Luthuli Central Hospital for a 24-month period was performed. Results: Of the 534 patients admitted to the trauma ICU, 420 were intubated and mechanically ventilated for 4 484 days. Forty events of UE occurred in 33 patients. The incidence of UE per 100 ventilator days was 0.89. UE was reported as unplanned self-extubation in 70% of cases and accidental self-extubation in 30%. Reintubation was required in 78% of patients and was strongly associated with the accidental nature of extubation where 100% of cases were reintubated. Mortality was lower in patients with a UE than the total study population (15% vs. 27.65% p = 0.12). Patients that required reintubation had longer durations of mechanical ventilation (15.5 days vs. 6 days p < 0.001) and longer ICU stays (17 days vs. 9 days p = 0.04). Conclusion: This study is in keeping with previously described incidences of UE in ICU; however, the rate is higher than suggested benchmarks. UE increased the need for mechanical ventilation and ICU care. Due to the increased incidence, ICU practices must be reviewed to improve this potentially modifiable adverse event.