• Quality Improvement in Health Care
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• v.9 no.1
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• pp.74-89
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• 2002

Background : The purpose of this study was to investigate the incidence of unplanned endotracheal extubation and to identify the influencing factor of unplanned extubation in ICUs for providing baseline data in developing prevention strategies and administrative standards. the medical records and hospital information system. In order to analyze factors related to unplanned extubation, the subjects of this study were divided by unplanned extubation group and planned extubation group and were matched by its sex, age, and disease groups in a ratio of one to two. The data were analyzed by descriptive statistics, ${\chi}^2$- test, t-test, Fisher's exact test, and logistic regression analysis with SPSSWIN 10.0 program. Result : 1) Forty-seven(4.99%) of 942 intubated patients experienced unplanned extubation 65 times during the twelve-month period. Thirtyfour( 72.34%) of 47 unplanned extubated patients required reintubation, whereas thirteen patients(27.66%) did not. 2) About half of unplanned extubation(46.8%) occurred during the night shift. 3) As for the nursing activity, respiratory nursing activity score(P=.0.06) and total nursing activity score(P=.011) showed statistically significant differences between unplanned extubation group and planned extubation group. 4) As for the patient status, unplanned extubation group showed more lower consciousness level(P=.000), more irritable or agitated behavior(P=.000), and had more applied physical restraints(P=.000) than planned extubation group. 5) As for the intubation related variables, unplanned extubation group revealed more intubated with respiratory failure(P=.000), more dependent on mechanical ventilation(P=.015) than planned extubation group. 6) Factors affecting unplanned extubations in intensive care unit patients were irritable or agitated behavior(odds ratio=13.757), night shift(odds ratio=7.166), and mechanical ventilation(odds ratio=6.257) from conditional logistic regression analysis. Conclusion : The most affecting factor of unplanned extubation was agitated or irritable behavior. Therefore the results of this study could be helpful to ICU nurses for meticulous care, decision making, timely intervention, and development of intervention strategies for preventing unplanned extubation.

• Tuberculosis and Respiratory Diseases
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• v.57 no.5
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• pp.439-442
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• 2004

Background : Extubation failure and reintubation increase the morbidity and the mortality rate. Several extubation criteria and risk factors for extubation failure have been recommended. However, some patients present with extubation failure even after a planned extubation. The aim of this study was to evaluate the clinical characteristics of patients with extubation failure after a planned extubation. Methods : Thirty one patients who presented with planned extubation were included. Extubation failure was defined as reintubation within 48 hours after extubation. The clinical, respiratory and hemodynamic parameters between extubation success and failure group were compared. Results : Six patients were included in the failure group. The extubation failure rate was 19.4%. The age, periods of intubation and heart rates were significantly different between the extubation success and failure group. In the success and failure group, the mean age were $60.4{\pm}15.65$ vs. $80.3{\pm}7.17$ year, the intubation periods were $7.12{\pm}2.47$ vs. $13.83{\pm}2.4$ day and the heart rates were $94.32{\pm}5.77$ vs. $110.67{\pm}3.78/min$, respectively. Conclusion : Old age and patients intubated for periods will require a will careful assessment before extubation. Extensive cardiac evaluations before extubation will also be needed.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.329-337
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• 1997

Background : Since endotracheal tube is the most important factor involved in the imposed work of breathing during mechanical ventilation, extubation of endotracheal tube is supposed to reduce respiratory work of patient. However, some patients show labored breathing after extubation despite acceptable blood gases. We investigated the changes of work of breathing before and after extubation and the factors involved in the change of WOB after extubation. Methods : The subjects were 34 patients(M : F = 20 : 14, mean age = $61{\pm}17yre$) who recovered from respiratory failure after ventilatory support and were considered to be ready for extubation. The patients with clinical or radiologic evidences of upper airway obstruction before endotracheal intubation for mechanical ventilation were excluded. Vital sign, physical examination, chest X-ray, work of breathing and other respiratory mechanic indices were measured prior to, immediately, 6, 24 and 48 hours after extubation serially. Definition of weaning failure after extubation was resumption of ventilatory support or reintubation of endotracheal tube within 48 hour after extubation because of respiratory failure. The patients were classified into group 1(decreased work of breathing), group 2(unchanged work of breathing) and group 3(increased work of breathing) depending on the statistical difference in the change of work of breathing before and after extubation. Results : Work of breathing decreased in 33%(11/34, group 1), unchanged in 41%(14/34, group 2) and increased in 26%(9/34, group 3) of patients after extubation compared with before extubation. Weaning failure occurred 9%(1/11) of group, 1, 28.6%(4/14) of group 2 and 44%(4/9) of group 3 after extubation(p = 0.07). The change of work of breathing after extubation was positively correlated with change of mean airway resistance(mRaw). (r = 0.794, p > 0.01). In three cases of group 3 whose respiratory indices could be measured until 48 hr after extubation, the change in work of breathing paralleled with the sequential change of mRaw. The work of breathing was peaked at 6 hr after extubation, which showed a tendency to decrease thereafter. Conclusions : Reversible increase of work of breathing after extubation may occur in the patients who underwent extubation, and the increase in mRaw could be responsible for the increase in work of breathing. In addition, the risk of weaning failure after extubation may increase in the patients who have increased WOB immediately after extubation.

• Korean Journal of Adult Nursing
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• v.24 no.5
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• pp.509-519
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• 2012

Purpose: This retrospective study was designed to examine the frequency of unplanned extubation, and to identify the related factors of unplanned extubation in medical intensive care unit patients. Methods: Data were collected from medical records of patients who received intubation in a medical intensive care unit. One hundred eighteen patient charts were selected for the study. The Patient Severity Classification Scale and unplanned extubation risk factors were examined. Data were analyzed with descriptive statistics, $x^2$-test, Fisher's exact test and Mann-Whitney U test. Results: The incidence of unplanned extubation was 11 (9.32%) out of 118 patients who had undergone intubation. There were statistically significant differences between the unplanned extubation and work shift ($x^2$=61.52, p=.001), ventilation mode (p=.001), number of days of ventilator application (U=366.00, p=.038) and administration of sedatives (p=.025). Conclusion: Unplanned extubation is affected by the following variables: a) whether a nurse is in night shift, b) whether ventilation is mandatory, c) duration of ventilation use and d) administration of sedatives.

• Tuberculosis and Respiratory Diseases
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• v.85 no.4
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• pp.332-340
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• 2022

Background: Cardiac dysfunction patients have long been considered at high risk of reintubation. However, it is based on past studies in which only conventional oxygen therapy was applied after extubation. We investigated association between cardiac dysfunction and reintubation rate in situation where high-flow nasal cannula (HFNC) was widely used during post-extubation period. Methods: We conducted a retrospective observational cohort study of patients treated with HFNC after planned extubation in medical intensive care unit of single tertiary center. Patients were divided into normal function group (ejection fraction [EF] ≥45%) and cardiac dysfunction group (EF <45%). The primary outcome was reintubation rate within 72 hours following extubation. Results: Of 270 patients, 35 (13%) had cardiac dysfunction. Baseline characteristics were similar in both groups. There were no differences in the changes in vital signs between the two groups during the first 12 hours after extubation except diastolic blood pressure. The reintubation rates were 20% and 17% for cardiac dysfunction group and normal function group, respectively (p=0.637). In a multivariate Cox regression analysis, cardiac dysfunction was not associated with an increased risk of reintubation within 72 hours following extubation (hazard ratio, 1.56; p=0.292). Conclusion: Cardiac dysfunction was not associated with increased reintubation rate within 72 hours when HFNC is immediately applied after planned extubation.

• Journal of Korean Academy of Nursing
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• v.42 no.1
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• pp.116-124
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• 2012

Purpose: The study was done to compare effects of two endotracheal tube (ET tube) fixation methods (rotated fixation versus conventional) on unplanned extubation and skin integrity for orally intubated patients in intensive care units. Methods: The research design was a non-equivalent control group with repeated measures design. Participants were 80 patients; 40 participants assigned to each group. ET tube for the experimental participants fixed with rotated method every morning. Unplanned extubation was assessed by bedside nurses using the unplanned extubation report form. Oral mucosa and facial skin integrity were assessed using oral assessment guide and facial skin integrity assessment guide at day 3, 7, 10 and 14. Results: There was no difference in the unplanned extubation rate between the two groups. Oral mucosa impairment scores for the rotated fixation method were significantly lower at day 7 (p=.044), 10 (p=.048) and day 14 (p=.037). Also facial skin integrity impairment scores for the same group were significantly lower at day 7 (p=.010), 10 (p=.003), and 14 (p=.002). Conclusion: Results of the study suggest that the rotated fixation method is effective for these patients, to prevent impairment of oral mucosa and facial skin integrity. Further research is needed to prevent unplanned extubation.

• Clinical and Experimental Pediatrics
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• v.48 no.5
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• pp.488-494
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• 2005

Purpose : To outline the aspects of extubation by birth weight and find the predictors for success/failure at the first extubation in extremely low birth weight infants. Methods : One hundred thirteen extremely low birth weight infants(<1,000 g) who were admitted to NICU at Samsung Seoul Hospital between Jan. 2000 and Jun. 2004 were enrolled. Clinical characteristics that are thought to be related with extubation success or failure were compared with the success and the failure of the first extubation. Results : As the birth weight decreased, extubation success day was significantly delayed : $16{\pm}3day(d)$ in 900-999 g; $20{\pm}3d$ in 800-899 g; $35{\pm}4d$ in 700-799 g; $37{\pm}9d$ in 600-699 g; $49{\pm}12d$ in ${\leq}599g$. 25 out of 113 infants(22%) failed the first extubation. Preterm premature rupture of membrane was associated with extubation success, and air leak was associated with extubation failure, with a borderline significance. Postnatal and corrected age and body weight at the first extubation, nutritional status, and ventilator settings were not associated with extubation success or failure. Extubation success day was significantly delayed, and the incidence of late-onset sepsis and mortality was significant higher in the failure of the first extubation. Conclusion : We could not find significant predictors for success/failure at the first extubation. The failure of the first extubation had an increased risk of late-onset sepsis and death. Further studies are needed to find the predictors for extubation success/failure.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.1
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• pp.64-68
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• 2000

Background and Objectives : To assess the role of altered vocal function in transient voice change after short-term endotracheal intubation, we evaluated acoustic parameters, aerodynamic parameters, and laryngoscopic characteristics preoperatively and postoperatively. Materials and Methods : Vocal function of 10 patients undergoing tympanoplasty and mastoidectomy using general anesthesia and endotracheal intubation were studied preoperatively, at 1day and 7 days after extubation. Acoustic analysis, aerodynamic study, and telescopic examination were used to assess vocal function. Results : In acoustic parameters, there was no significant difference between preoperative and postoperative measures. However, in subglottic pressure, ere was a significant decrease at 1 day after extubation and this change was return to preoperative value at 7 days after extubation. MPT(Maximal Phonation Time), MER(Mean flow Ratio), and VC(Vital Capacity) were decreased 1 day after extubation but did not show statistically significant change. Three of 10 patients manifested a vocal fold edema and injection 1 day after extubation. Conclusions : Subglottic pressure revealed a significant decrease at 1 day after extubation. And this change was correlated with laryngeal morphologic change and decrement in pulmonary function.

• Journal of Chest Surgery
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• v.51 no.4
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• pp.247-253
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• 2018

Background: Early extubation after cardiovascular surgery has some clinical advantages, including reduced hospitalization costs. Herein, we review the results of ultra-fast-track (UFT) extubation, which refers to extubation performed on the operating table just after the operation, or within 1-2 hours after surgery, in patients with congenital cardiac disease. Methods: We performed UFT extubation in patients (n=72) with a relatively simple congenital cardiac defect or who underwent a simple operation starting in September 2016. To evaluate the feasibility and effectiveness of our recently introduced UFT extubation strategy, we retrospectively reviewed 195 patients who underwent similar operations for similar diseases from September 2015 to September 2017, including the 1-year periods immediately before and after the introduction of the UFT extubation protocol. Propensity scores were used to assess the effects of UFT extubation on length of stay (LOS) in the intensive care unit (ICU), hospital LOS, and medical costs. Results: After propensity-score matching using logistic regression analysis, 47 patients were matched in each group. The mean ICU LOS ($16.3{\pm}28.6$ [UFT] vs. $28.0{\pm}16.8$ [non-UFT] hours, p=0.018) was significantly shorter in the UFT group. The total medical costs ($182.6{\pm}3.5$ [UFT] vs. $187.1{\pm}55.6$ [non-UFT] ${\times}100,000$ Korean won [KRW], p=0.639) and hospital stay expenses ($48.3{\pm}13.6$ [UFT] vs. $54.8{\pm}29.0$ [non-UFT] ${\times}100,000KRW$, p=0.164) did not significantly differ between the groups. Conclusion: UFT extubation decreased the ICU LOS and mechanical ventilation time, but was not associated with postoperative hospital LOS or medical expenses in patients with simple congenital cardiac disease.

• Tuberculosis and Respiratory Diseases
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• v.83 no.4
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• pp.295-302
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• 2020

Background: Weaning failure is common in mechanically ventilated patients, and if ultrasound can predict weaning outcome remains controversial. The purpose of this study was to evaluate the diaphragmatic function (thickness and excursion) measured by ultrasound as a predictor of the extubation outcome. Methods: We included 62 mechanically ventilated patients from the chest intensive care unit in this study. Sixty-two patients who successfully passed the spontaneous breathing trial (SBT) were enrolled. The transthoracic ultrasound of the diaphragm was performed during an SBT to the assess diaphragmatic function (excursion and thickness), and they were classified into the successful extubation group and the failed extubation group. Results: There was a statistically significant increase in the successful extubation group in the diaphragmatic excursion and thickness fraction (p<0.001), a statistically significant negative correlation between the diaphragmatic function and the duration of the mechanical ventilation, and a statistically significant negative correlation between the diaphragmatic excursion and the Acute Physiology and Chronic Health Evaluation II. The diaphragmatic excursion cut-off value predictive of weaning was 1.25 cm, with a specificity of 82.1% and a sensitivity of 97.1% respectively, and the diaphragmatic thickness cut-off value predictive of weaning was 21.5%, with a specificity of 60.7% and a sensitivity of 91.2%, respectively. Conclusion: The diaphragmatic ultrasonography was found to be a promising tool for predicting the extubation outcome for mechanically ventilated patients.