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Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units

Most reports regarding unplanned extubation (UE) are case-control studies with matching age and disease severity. To avoid diminishing differences in matched factors, this study with only matching duration of mechanical ventilation aimed to re-examine the risk factors and the factors governing outco...

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Autores principales: Chuang, Ming-Lung, Lee, Chai-Yuan, Chen, Yi-Fang, Huang, Shih-Feng, Lin, I-Feng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617893/
https://www.ncbi.nlm.nih.gov/pubmed/26484674
http://dx.doi.org/10.1371/journal.pone.0139864
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author Chuang, Ming-Lung
Lee, Chai-Yuan
Chen, Yi-Fang
Huang, Shih-Feng
Lin, I-Feng
author_facet Chuang, Ming-Lung
Lee, Chai-Yuan
Chen, Yi-Fang
Huang, Shih-Feng
Lin, I-Feng
author_sort Chuang, Ming-Lung
collection PubMed
description Most reports regarding unplanned extubation (UE) are case-control studies with matching age and disease severity. To avoid diminishing differences in matched factors, this study with only matching duration of mechanical ventilation aimed to re-examine the risk factors and the factors governing outcomes of UE in intensive care units (ICUs). This case-control study was conducted on 1,775 subjects intubated for mechanical ventilation. Thirty-seven (2.1%) subjects with UE were identified, and 156 non-UE subjects were randomly selected as the control group. Demographic data, acute Physiological and Chronic Health Evaluation II (APACHE II) scores, and outcomes of UE were compared between the two groups. Logistic regression analysis was used to identify the risk factors of UE. Milder disease, younger age, and higher Glasgow Coma Scale (GCS) scores with more frequently being physically restrained (all p<0.05) were related to UE. Logistic regression revealed that APACHE II score (odds ratio (OR) 0.91, p<0.01), respiratory infection (OR 0.24, p<0.01), physical restraint (OR 5.36, p<0.001), and certain specific diseases (OR 3.79–5.62, p<0.05) were related to UE. The UE patients had a lower ICU mortality rate (p<0.01) and a trend of lower in-hospital mortality rate (p = 0.08). Cox regression analysis revealed that in-hospital mortality was associated with APACHE II score, age, shock, and oxygen used, all of which were co-linear, but not UE. The results showed that milder disease with higher GCS scores thereby requiring a higher use of physical restraints were related to UE. Disease severity but not UE was associated with in-hospital mortality.
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spelling pubmed-46178932015-10-29 Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units Chuang, Ming-Lung Lee, Chai-Yuan Chen, Yi-Fang Huang, Shih-Feng Lin, I-Feng PLoS One Research Article Most reports regarding unplanned extubation (UE) are case-control studies with matching age and disease severity. To avoid diminishing differences in matched factors, this study with only matching duration of mechanical ventilation aimed to re-examine the risk factors and the factors governing outcomes of UE in intensive care units (ICUs). This case-control study was conducted on 1,775 subjects intubated for mechanical ventilation. Thirty-seven (2.1%) subjects with UE were identified, and 156 non-UE subjects were randomly selected as the control group. Demographic data, acute Physiological and Chronic Health Evaluation II (APACHE II) scores, and outcomes of UE were compared between the two groups. Logistic regression analysis was used to identify the risk factors of UE. Milder disease, younger age, and higher Glasgow Coma Scale (GCS) scores with more frequently being physically restrained (all p<0.05) were related to UE. Logistic regression revealed that APACHE II score (odds ratio (OR) 0.91, p<0.01), respiratory infection (OR 0.24, p<0.01), physical restraint (OR 5.36, p<0.001), and certain specific diseases (OR 3.79–5.62, p<0.05) were related to UE. The UE patients had a lower ICU mortality rate (p<0.01) and a trend of lower in-hospital mortality rate (p = 0.08). Cox regression analysis revealed that in-hospital mortality was associated with APACHE II score, age, shock, and oxygen used, all of which were co-linear, but not UE. The results showed that milder disease with higher GCS scores thereby requiring a higher use of physical restraints were related to UE. Disease severity but not UE was associated with in-hospital mortality. Public Library of Science 2015-10-20 /pmc/articles/PMC4617893/ /pubmed/26484674 http://dx.doi.org/10.1371/journal.pone.0139864 Text en © 2015 Chuang et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Chuang, Ming-Lung
Lee, Chai-Yuan
Chen, Yi-Fang
Huang, Shih-Feng
Lin, I-Feng
Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units
title Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units
title_full Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units
title_fullStr Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units
title_full_unstemmed Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units
title_short Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units
title_sort revisiting unplanned endotracheal extubation and disease severity in intensive care units
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617893/
https://www.ncbi.nlm.nih.gov/pubmed/26484674
http://dx.doi.org/10.1371/journal.pone.0139864
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