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Background <p>Self-extubation is a common complication in intubated patients in the intensive care unit (ICU) and is associated with a high rate of reintubation. This study aimed to identify predictors of reintubation following self-extubation (SE) and assess the prognosis of these patients.</p> Methods <p>Data were extracted from the French ICU database, OutcomeRea™. The primary objective was to identify factors associated with reintubation within 48&#xa0;h after self-extubation. Secondary objectives included evaluating the association between reintubation and mortality, ICU length of stay, and nosocomial pneumonia.</p> Results <p>Between November 1996 and May 2022, 12,917 patients were intubated in the ICU. Among them, 701 patients experienced SE without therapeutic limitations at the time, and 276 (39.4%) required reintubation. In adjusted analyses, the following factors were independently associated with reintubation: a higher non-neurological SOFA score on the day before SE (OR 1.16 [1.01; 1.34]; p = 0.03), duration of invasive mechanical ventilation &gt; 7&#xa0;days before SE (OR 1.79 [1.04; 3.26]; p = 0.04), enteral nutrition on the day of SE (OR 2.59 [1.75; 3.84]; p &lt; 0.01) and the use of non-invasive ventilation (NIV) within 24&#xa0;h after SE (OR 0.28 [0.16; 0.5];p &lt; 0.01). Reintubation within 48&#xa0;h after SE was independently associated with increased 28-day mortality (HR = 3.03 [1.79; 5.12]; p &lt; 0.01) and 90-day mortality (HR = 2.86 [1.86; 4.4]; p &lt; 0.01), a higher risk of nosocomial pneumonia (sdHR, 18.28 [7.70; 43.42]; p &lt; 0.01), and a 13-day increase in ICU length of stay (p &lt; 0.01).</p> Conclusion <p>Enteral nutrition on the day of SE, prolonged mechanical ventilation prior to SE, higher non-neurological SOFA scores, and use of NIV after SE were independently associated with the need for reintubation. Reintubation was also associated with increased mortality, a higher risk of nosocomial pneumonia, and prolonged ICU stay.</p>

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Self-extubation in critically ill patients: from the French OUTCOMEREA Network

  • 期刊论文

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  • 发表日期：

    2025年7月7日

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  • Léa Trenchat,
  • Louis-Marie Galerneau,
  • Stéphane Ruckly,
  • Florian Sigaud,
  • Nicolas Terzi,
  • Maité Garrouste,
  • Johanna Oziel,
  • Vivien Hong Tuan Ha,
  • Marc Gainnier,
  • Shidasp Siami,
  • Anaïs Dartevel,
  • Claire Dupuis,
  • Jean-Marie Forel,
  • Julien Dessajan,
  • Christophe Adrie,
  • Dany Goldgran-Toledano,
  • Virginie Laurent,
  • Laurent Argaud,
  • Jean Reignier,
  • Guillaume Dumas,
  • Michael Darmon,
  • Jean-François Timsit,
  • Elie Azoulay,
  • Maïté Garrouste-Orgeas,
  • Jean-Ralph Zahar,
  • Bruno Mourvillier,
  • Niccolo Buetti,
  • Corinne Alberti,
  • Stephane Ruckly,
  • Sébastien Bailly,
  • Aurélien Vannieuwenhuyze,
  • Carole Agasse,
  • Bernard Allaouchiche,
  • Olivier Andremont,
  • Pascal Andreu,
  • Elie Azoulay,
  • Francois Barbier,
  • Jean-Pierre Bedos,
  • Jérome Bedel,
  • Asael Berger,
  • Julien Bohé,
  • Lila Bouadma,
  • Jeremy Bourenne,
  • Noel Brule,
  • Frank Chemouni,
  • Julien Carvelli,
  • Martin Cour,
  • Anais Dartevelle,
  • Etienne de Montmollin,
  • Marc Doman,
  • Loa Dopeux,
  • Anne-Sylvie Dumenil,
  • Jean-Marc Forel,
  • Charlotte Garret,
  • Steven Grangé,
  • Antoine Gros,
  • Hédia Hammed,
  • Akim Haouache,
  • Tarik Hissem,
  • Sébastien Jochmans,
  • Jean-Baptiste Joffredo,
  • Hatem Kallel,
  • Guillaume Lacave,
  • Alexandre Lautrette,
  • Clément Le bihan,
  • Virgine Lemiale,
  • David Luis,
  • Jordane Lebut,
  • Bruno Mourvillier,
  • Benoît Misset,
  • Bruno Mourvillier,
  • Mathild Neuville,
  • Laurent Nicolet,
  • Laurent Papazian,
  • Juliette Patrier,
  • Benjamin Planquette,
  • Aguila Radjou,
  • Romain Sonneville,
  • Bertrand Souweine,
  • Carole Schwebel,
  • Romain Sonneville,
  • Michael thy,
  • Gilles Troché,
  • Fabrice Thiollieres,
  • Guillaume Thierry,
  • Michael Thy,
  • Guillaume Van Der Meersch,
  • Marion Venot,
  • Florent Wallet,
  • Sondes Yaacoubi,
  • Olivier Zambon,
  • Jonathan Zarka,
  • Kévin grapin,
  • Francois thouy,
  • Laure Calvet,
  • kevin Grapin,
  • guillaume laurichesse,
  • Neven STEVIC,
  • Mireille Adda,
  • Clémence Barberot,
  • Vanessa Vindrieux,
  • Marion Provent,
  • Pauline Enguerrand,
  • Vincent Gobert,
  • Stéphane Guessens,
  • Helene Merle,
  • Nadira Kaddour,
  • Boris Berthe,
  • Samir Bekkhouche,
  • Kaouttar Mellouk,
  • Mélaine Lebrazic,
  • Carole Ouisse,
  • Diane Maugars,
  • Christelle Aparicio,
  • Igor Theodose,
  • Manal Nouacer,
  • Veronique Deiler,
  • Fariza Nait Sidenas,
  • Myriam Moussa,
  • Atika Mouaci,
  • Nassima Viguier

摘要

Background

Self-extubation is a common complication in intubated patients in the intensive care unit (ICU) and is associated with a high rate of reintubation. This study aimed to identify predictors of reintubation following self-extubation (SE) and assess the prognosis of these patients.

Methods

Data were extracted from the French ICU database, OutcomeRea™. The primary objective was to identify factors associated with reintubation within 48 h after self-extubation. Secondary objectives included evaluating the association between reintubation and mortality, ICU length of stay, and nosocomial pneumonia.

Results

Between November 1996 and May 2022, 12,917 patients were intubated in the ICU. Among them, 701 patients experienced SE without therapeutic limitations at the time, and 276 (39.4%) required reintubation. In adjusted analyses, the following factors were independently associated with reintubation: a higher non-neurological SOFA score on the day before SE (OR 1.16 [1.01; 1.34]; p = 0.03), duration of invasive mechanical ventilation > 7 days before SE (OR 1.79 [1.04; 3.26]; p = 0.04), enteral nutrition on the day of SE (OR 2.59 [1.75; 3.84]; p < 0.01) and the use of non-invasive ventilation (NIV) within 24 h after SE (OR 0.28 [0.16; 0.5];p < 0.01). Reintubation within 48 h after SE was independently associated with increased 28-day mortality (HR = 3.03 [1.79; 5.12]; p < 0.01) and 90-day mortality (HR = 2.86 [1.86; 4.4]; p < 0.01), a higher risk of nosocomial pneumonia (sdHR, 18.28 [7.70; 43.42]; p < 0.01), and a 13-day increase in ICU length of stay (p < 0.01).

Conclusion

Enteral nutrition on the day of SE, prolonged mechanical ventilation prior to SE, higher non-neurological SOFA scores, and use of NIV after SE were independently associated with the need for reintubation. Reintubation was also associated with increased mortality, a higher risk of nosocomial pneumonia, and prolonged ICU stay.