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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| 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 |
| doi_str_mv | 10.1371/journal.pone.0139864 |
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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.]]></description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0139864</identifier><identifier>PMID: 26484674</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Age Factors ; Aged ; Aged, 80 and over ; Airway Extubation ; Anesthesia ; Case-Control Studies ; Coma ; Critical care ; Critical Illness - mortality ; Critical Illness - therapy ; Demographics ; Disease control ; Extubation ; Female ; Health risks ; Hospital Mortality ; Hospitals ; Humans ; Hypothesis testing ; Intensive care ; Intensive Care Units ; Intubation ; Male ; Management ; Matching ; Mechanical ventilation ; Medical records ; Medicine ; Middle Aged ; Mortality ; Nurses ; Nursing care ; Ostomy ; Oxygen ; Patients ; Physical restraints ; Practice ; Regression analysis ; Respiration, Artificial - methods ; Review boards ; Risk analysis ; Risk Factors ; Severity of Illness Index ; Studies ; Ventilation ; Ventilators</subject><ispartof>PloS one, 2015-10, Vol.10 (10), p.e0139864-e0139864</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Chuang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Chuang et al 2015 Chuang et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-b2d1f54feeeccde37c72bb6d480568202e9cd31804b0b994fb3b9f97b9b342a3</citedby><cites>FETCH-LOGICAL-c758t-b2d1f54feeeccde37c72bb6d480568202e9cd31804b0b994fb3b9f97b9b342a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617893/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617893/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26484674$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chuang, Ming-Lung</creatorcontrib><creatorcontrib>Lee, Chai-Yuan</creatorcontrib><creatorcontrib>Chen, Yi-Fang</creatorcontrib><creatorcontrib>Huang, Shih-Feng</creatorcontrib><creatorcontrib>Lin, I-Feng</creatorcontrib><title>Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units</title><title>PloS one</title><addtitle>PLoS One</addtitle><description><![CDATA[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.]]></description><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Airway Extubation</subject><subject>Anesthesia</subject><subject>Case-Control Studies</subject><subject>Coma</subject><subject>Critical care</subject><subject>Critical Illness - mortality</subject><subject>Critical Illness - therapy</subject><subject>Demographics</subject><subject>Disease control</subject><subject>Extubation</subject><subject>Female</subject><subject>Health risks</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypothesis testing</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Intubation</subject><subject>Male</subject><subject>Management</subject><subject>Matching</subject><subject>Mechanical ventilation</subject><subject>Medical records</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nurses</subject><subject>Nursing care</subject><subject>Ostomy</subject><subject>Oxygen</subject><subject>Patients</subject><subject>Physical restraints</subject><subject>Practice</subject><subject>Regression analysis</subject><subject>Respiration, Artificial - methods</subject><subject>Review boards</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Studies</subject><subject>Ventilation</subject><subject>Ventilators</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11rFDEUhgdRbK3-A9EBQfRi13zNTOZGKOuqC4VCWwWvQpI52c0ym2wnmaX992Y_WnakF5KLhJPnvEnenJNlbzEaY1rhL0vfd06247V3MEaY1rxkz7JTXFMyKgmiz4_WJ9mrEJYIFZSX5cvshJSMs7Jip9mfK9jYYKN18_yXW7fSOWjyqWt87KRegGzz6V3slYzWu1y6Jv9mA8gA-TVsoLPxPrcun7kILtgN5BPZQRKyMbzOXhjZBnhzmM-ym-_Tm8nP0cXlj9nk_GKkq4LHkSINNgUzAKB1A7TSFVGqbBhHRckJIlDrhmKOmEKqrplRVNWmrlStKCOSnmXv97Lr1gdxMCUIXBFGCk44SsRsTzReLsW6syvZ3QsvrdgFfDcXsotWtyBKo2rEMMJQMIZqqQBRzQuEjDSmbFTS-no4rVcraDS4ZFM7EB3uOLsQc78RrMQVr2kS-HQQ6PxtDyGKlQ0a2mQ8-H5376LAhJMqoR_-QZ9-3YGay_QA68zu47ai4pxRgilGlCVq_ASVRgMrq1MFGZvig4TPg4TERLiLc9mHIGbXV__PXv4esh-P2G19xUXwbb8trzAE2R7UnQ-hA_NoMkZi2wAPbohtA4hDA6S0d8cf9Jj0UPH0L84hAKY</recordid><startdate>20151020</startdate><enddate>20151020</enddate><creator>Chuang, Ming-Lung</creator><creator>Lee, Chai-Yuan</creator><creator>Chen, Yi-Fang</creator><creator>Huang, Shih-Feng</creator><creator>Lin, I-Feng</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20151020</creationdate><title>Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units</title><author>Chuang, Ming-Lung ; Lee, Chai-Yuan ; Chen, Yi-Fang ; Huang, Shih-Feng ; Lin, I-Feng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-b2d1f54feeeccde37c72bb6d480568202e9cd31804b0b994fb3b9f97b9b342a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Age</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Airway Extubation</topic><topic>Anesthesia</topic><topic>Case-Control Studies</topic><topic>Coma</topic><topic>Critical care</topic><topic>Critical Illness - mortality</topic><topic>Critical Illness - therapy</topic><topic>Demographics</topic><topic>Disease control</topic><topic>Extubation</topic><topic>Female</topic><topic>Health risks</topic><topic>Hospital Mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypothesis testing</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Intubation</topic><topic>Male</topic><topic>Management</topic><topic>Matching</topic><topic>Mechanical ventilation</topic><topic>Medical records</topic><topic>Medicine</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nurses</topic><topic>Nursing care</topic><topic>Ostomy</topic><topic>Oxygen</topic><topic>Patients</topic><topic>Physical restraints</topic><topic>Practice</topic><topic>Regression analysis</topic><topic>Respiration, Artificial - methods</topic><topic>Review boards</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Studies</topic><topic>Ventilation</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chuang, Ming-Lung</creatorcontrib><creatorcontrib>Lee, Chai-Yuan</creatorcontrib><creatorcontrib>Chen, Yi-Fang</creatorcontrib><creatorcontrib>Huang, Shih-Feng</creatorcontrib><creatorcontrib>Lin, I-Feng</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chuang, Ming-Lung</au><au>Lee, Chai-Yuan</au><au>Chen, Yi-Fang</au><au>Huang, Shih-Feng</au><au>Lin, I-Feng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-10-20</date><risdate>2015</risdate><volume>10</volume><issue>10</issue><spage>e0139864</spage><epage>e0139864</epage><pages>e0139864-e0139864</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract><![CDATA[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.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26484674</pmid><doi>10.1371/journal.pone.0139864</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Age Age Factors Aged Aged, 80 and over Airway Extubation Anesthesia Case-Control Studies Coma Critical care Critical Illness - mortality Critical Illness - therapy Demographics Disease control Extubation Female Health risks Hospital Mortality Hospitals Humans Hypothesis testing Intensive care Intensive Care Units Intubation Male Management Matching Mechanical ventilation Medical records Medicine Middle Aged Mortality Nurses Nursing care Ostomy Oxygen Patients Physical restraints Practice Regression analysis Respiration, Artificial - methods Review boards Risk analysis Risk Factors Severity of Illness Index Studies Ventilation Ventilators |
| title | Revisiting Unplanned Endotracheal Extubation and Disease Severity in Intensive Care Units |
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