중환자실 환자에서 비계획적 발관 후 재삽관 예측인자

Abstract

Background: Unplanned endotracheal extubation is a potentially serious complication, as some patients may need reintubation while in very critical conditions that may increase the morbidity and mortality rates. We conducted a study to evaluate the predictors for reintubation after unplanned extubation. Methods: Patients who presented unplanned extubation over a 35-month period in two multi-disciplinary intensive care units of university affiliated hospital were included. Any replacement of an endotracheal tube within 48 hours after unplanned extubation was considered as reintubaton. Results: There were 62 episodes of unplanned endotracheal extubation in 56 patients (incidence rate 2.8％). Fifty seven episodes (91.9％) were deliberate self-extubation, while 5 episodes (8.1％) were accidental extubation. Reintubation was required in 42 episodes (67.6％). Only 44.4％ (12/27) of the patients who presented unplanned extubation required reintubation during weaning period, while reintubation was mandatory in 85.7％ (30/35) of the patients who presented unplanned extubation during full ventilatory support (p<0.001). The multiple logistic regression analysis was made to obtain a model to predict the need for reintubation as a dependent variable: ventilatory support mode (odds ratio: 12.0) was significantly associated with the need for reintubation. The model correctly classified the need of reintubation extubation strongly depended on the type of the mechanical ventilatory support. The probability of requiring reintubation after unplanned extubation was higher during full ventilatory support than during weaning period.