Superficial placement of endotracheal tubes associated with unplanned extubation: A case-control study

Teressa Reanne Ju; Emily Wang; Christian Castaneda; Anisha Rathod; Olumayowa Abe

doi:10.1016/j.jcrc.2021.09.010

Superficial placement of endotracheal tubes associated with unplanned extubation: A case-control study

J Crit Care. 2022 Feb:67:39-43. doi: 10.1016/j.jcrc.2021.09.010. Epub 2021 Oct 11.

Authors

Teressa Reanne Ju¹, Emily Wang², Christian Castaneda³, Anisha Rathod⁴, Olumayowa Abe⁵

Affiliations

¹ Department of Medicine, NewYork-Presbyterian Queens Hospital, Flushing, NY, USA. Electronic address: tej9016@nyp.org.
² Department of Medicine, NewYork-Presbyterian Queens Hospital, Flushing, NY, USA.
³ Department of Medicine, Division of Pulmonary and Critical Care, NewYork-Presbyterian Queens Hospital, Flushing, NY, USA.
⁴ Department of Respiratory Therapy, NewYork-Presbyterian Queens Hospital, Flushing, NY, USA.
⁵ Department of Medicine, Division of Pulmonary and Critical Care, NewYork-Presbyterian Queens Hospital, Flushing, NY, USA; Weill Cornell Medical College, Cornell University, NY, New York, United States of America.

PMID: 34649093
DOI: 10.1016/j.jcrc.2021.09.010

Abstract

Introduction: Unplanned extubations (UEs) refer to the inadvertent removal of endotracheal tubes (ETTs). Superficially placed ETTs anecdotally increases the risk of UEs. This study aims to assess the impact of ETT position as well as other factors that could be associated with risk of UEs.

Method: A retrospective case-control study was conducted at NewYork-Presbyterian Queens Hospital from January 2017 to February 2020. All adults admitted to intensive care units (ICUs) who received mechanical ventilation (MV) through ETTs were screened to identify UEs. For each case with UE, two controls with planned extubation were identified. A multivariate logistic regression was conducted to identify risk factors associated with UEs.

Results: 1100 patients received MV through ETTs during the time period. The incidence of UE was 4.9%. 53 patients with UEs and 106 patients with planned extubation were included for statistical analysis. Overall, patients with UE had higher in-hospital mortality rates (26.4% versus 11.3%, P = 0.02) and reintubation rates (28.3% versus 6.6%, P < 0.001). Within the UE group, patients who required reintubation had significantly higher in-hospital mortality rates than those who did not require reintubation (53.3% versus 15.8%, P = 0.005). Multivariate logistic regression showed higher APACHE II scores (Odds ratios (OR) 1.07; 95% Confidence interval (CI), 1 to 1.13), distance of ETT tips to carina ≥6 cm (OR 6.41; 95% CI, 1.1 to 37.3), physical restraint use (OR 2.98; 95% CI, 1.28 to 6.95) and continuous infusions of sedatives and/or analgesics (OR 10.72, 95% CI, 4.19 to 27.43) were associated with UE.

Conclusion: UE and the need for reintubation is associated with worse outcomes. Distance of ETT tips to carina ≥6 cm may be associated with higher risks of UE. Further prospective studies are needed to establish the optimal position of ETT to prevent UE.

Keywords: Airway extubation; Airway management; Complications; Extubation; Tracheal extubation.

MeSH terms

Adult
Airway Extubation* / adverse effects
Case-Control Studies
Humans
Intensive Care Units
Intubation, Intratracheal*
Respiration, Artificial / adverse effects
Retrospective Studies