Chest
Clinical Investigations in Critical CareCharacteristics and Outcomes of Patients Who Self-Extubate From Ventilatory Support: A Case-Control Study
Section snippets
Setting and Sample
The study took place at the Cleveland Clinic Foundation, a 1,000-bed national referral center. Cleveland Clinic Foundation has nine adult ICUs (n = 100 beds) with >3,000 patients a year receiving mechanical ventilation.
The cases consisted of all adult patients with occurrences of purposeful SE from mechanical ventilation who were reported by nursing staff to the nursing quality management office during 1993. We defined SE as purposeful patient removal of the ET as witnessed by the nursing
RESULTS
One hundred fifty patients comprised the study sample; 50 who were SE each matched to two patients who were NSE. Results from the univariate analyses are displayed in Table 2, Table 3, Table 4. Table 2 displays the hospital variables for each group. Marginally more of the NSE group returned to home, had a lower rate of discharge to a long-term care setting, and a lower rate of death compared to those in the SE group. Significantly more of the NSE group had a surgical procedure (75%; vs 48%;,
DISCUSSION
SE from mechanical ventilation is a major concern for health-care professionals in the care of ventilated patients. Only a few studies have examined patient factors associated with outcomes of SE.1,5 This retrospective case-control study was conducted to further extend previous work in this area. We found that cases compared to control patients were more often restless or agitated and had more hospital-acquired complications. Furthermore, 25%; of the SE patients did not require reintubation,
Reference (21)
- et al.
Self-extubations: a 12-month experience
Chest
(1990) - et al.
Acute complications of endotracheal intubation: relationship to reintubation, route, urgency, and duration
Chest
(1986) - et al.
Complications and consequences of endotracheal intubation and tracheotomy: a prospective study of 150 critically ill adult patients
Am J Med
(1981) - et al.
Unplanned extubations
Chest
(1994) - et al.
Unplanned extubation: predictors of successful termination of mechanical ventilatory support
Chest
(1994) - et al.
Complications of assisted ventilation: a prospective study of 354 consecutive episodes
Am J Med
(1974) The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients
Am J Med
(1994)- et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Self-extubation
Chest
(1991) - et al.
Decreasing unplanned extubations in the surgical intensive care unit
Am J Surg
(1995)
Cited by (0)
Presented in part at the 1996 annual meetings of the American Geriatrics Society/American Federation of Aging Research, Chicago
Reprint requests: Lorraine Mion, PhD, RN, Dept of Nursing Research, P32, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195