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Development of a risk assessment tool for deliberate self-extubation in intensive care patients

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Abstract

Objective

To develop a risk stratification scheme for deliberate self-extubation in intensive care patients.

Design

A nested case-control study.

Setting

Four surgical ICUs, one medical ICU, one coronary care unit, and one emergency department of a tertiary care center.

Measurement

In a 3-month period, the number of ventilation periods, ventilation days, and unplanned extubations were recorded. Potential determinants of unplanned extubation were assessed with a translated (English to Dutch) and modified version of the “Unplanned Extubation Data Collection Tool.”

Patients

Clinical and demographic characteristics and circumstances of the 26 unplanned extubations were compared with those of 48 randomly selected control patients who did not experience unplanned extubation.

Results

The incidence of unplanned extubation was 4.2%, corresponding to 0.68 unplanned extubations per 100 ventilation days. The incidence was substantially lower at surgical ICUs (2.6%) compared with that at medical ICU/CCUs (9.5%). Multiple logistic regression analysis revealed that patients with a low sedation level (Bloomsbury Sedation Score) and a higher degree of consciousness (Glasgow Coma Scale) were at higher risk for deliberate self-extubation. The explained variance of this model including these factors was 67.3%.

Conclusion

Based on the risk factors identified, a risk assessment tool was developed. Systematic administration of the Bloomsbury Sedation Score and the Glasgow Coma Scale, and the use of the stratification scheme, allows identification of patients at risk. Appropriate reduction of sedative drugs during weaning, a timely extubation, and increased surveillance in patients identified to be at risk are possible interventions to diminish the number of unplanned extubations.

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Acknowledgements

The authors gratefully thank P. Lauwers, H. Bobbaers, F. Van de Werf, and H. Delooz of the University Hospitals of Leuven (Belgium) for their participation in this study. S. Fieuws is acknowledged for statistical advice.

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Authors and Affiliations

  1. Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium

    Philip Moons, Kristine Sels & Sabina De Geest

  2. Department of Intensive Care Medicine, University Hospitals of Leuven, Herestraat 49, Leuven, Belgium

    Wilfried De Becker & Patrick Ferdinande

  3. Institute of Nursing Science, University of Basel, Bernoullistrasse 28, Basel, Switzerland

    Sabina De Geest

Authors
  1. Philip Moons
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  2. Kristine Sels
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  3. Wilfried De Becker
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  4. Sabina De Geest
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  5. Patrick Ferdinande
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Corresponding author

Correspondence to Philip Moons.

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Moons, P., Sels, K., De Becker, W. et al. Development of a risk assessment tool for deliberate self-extubation in intensive care patients. Intensive Care Med 30, 1348–1355 (2004). https://doi.org/10.1007/s00134-004-2228-2

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  • DOI: https://doi.org/10.1007/s00134-004-2228-2

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