Chest
Volume 120, Issue 2, August 2001, Pages 538-542
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Clinical Investigations in Critical Care
Factors Associated With Reintubation in Intensive Care: An Analysis of Causes and Outcomes

https://doi.org/10.1378/chest.120.2.538Get rights and content

Introduction

Reports on reintubation have focused on patients in whom planned extubation has been unsuccessful or those who have been accidentally extubated. However, reintubation is often required in events not related to accidental extubation. These cases have not been well described previously.

Objectives

To examine the causes, outcomes, and contributing factors associated with patients who required reintubation for events not including accidental extubation.

Methods

Appropriate reintubation incidents were extracted from the Australian Incident Monitoring Study in Intensive Care database and analyzed using descriptive methodology.

Results

One hundred forty-three incidents were identified with prominent precipitating events, including tube malposition (17%), securing/taping problems (17%), pilot tube/cuff problem (16%), blocked/kinked airway (14%), failed extubation (14%), and poor planning for extubation (6%). Narrative description of morbidity included hypoxia in 25% of reports, hypercarbic respiratory failure in 12%, aspiration in 7%, sputum retention in 7%, and cardiac arrhythmias in 6%. The reporter selected“ major physiologic complications” and “prolonged hospital stay” as prominent adverse outcomes in 52% and 16% of patients, respectively. Major factors contributing to reintubation involved“ error of judgement/problem recognition” (identified in 62% of reports), “high unit activity” (20%), “difficult patient habitus” (26%), and “lack of patient cooperation” (14%). Rechecking patient and equipment, and skilled assistance were prominent factors in limiting the adverse consequences of the incident.

Conclusion

This study indicated that reintubation not related to accidental extubation resulted in major physiologic complications and potentially contributed to increased length of stay. Its findings suggest that the adequate provision of highly qualified, intensive-care-trained staff is essential for the avoidance or minimization of these incidents.

Section snippets

Materials and Methods

Following medical and nursing collaboration, the AIMS-ICU study was established in 1993 to provide an anonymous, voluntary incident reporting system for ICUs throughout Australia and New Zealand. The initial development and methodology of this project have been described previously.1920 More than 90 ICUs were registered with the project at the time of this review.

An incident was defined as any unintended event or outcome that could have, or did, reduce the safety margin for the patient. It may

Results

Since 1993, 93 units had progressively enrolled in the AIMS-ICU study. By December 1999, these units had contributed 7,525 reports describing > 11,000 incidents. These incidents fall into five major categories: (1) airway and ventilation (n = 1,829), (2) drugs and therapeutics (n = 2,744), (3) procedures, lines, and equipment (n = 2,687), (4) patient management and environment (n = 2,267), and (5) unit management (n = 1,572). Reintubation incidents are included in the first category; 241

Discussion

Quality has become a major issue in health-care provision by both nursing and medical staff in the intensive-care environment. The need for measurement of quality based on patient outcomes and complications remains a complex problem. Incident reporting is well established in Australia and New Zealand ICUs through the AIMS-ICU study. This study provides reporting of incidents, which permit the identification of active and latent errors. The reporters of incidents are health professionals

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