Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 18 , ISSUE 5 ( May, 2014 ) > List of Articles

RESEARCH ARTICLE

A prolonged observational study of tracheal tube displacements: Benchmarking an incidence <0.5-1% in a medical-surgical adult intensive care unit

Pandurang C. Tekawade, Shruti S. Nath, Sharad S. Pachpute, Sanjay S. Saverkar, Rupali A. Bhise, Aarti C. Chavan, Sholly J. Varghese, Vidya U. Kantak, Rohini V. Kshirsagar, Vaishali A. Neve, Samona O. D′souza

Keywords : Airway accidents, endotracheal tube, tracheostomy tube, unplanned extubation

Citation Information : Tekawade PC, Nath SS, Pachpute SS, Saverkar SS, Bhise RA, Chavan AC, Varghese SJ, Kantak VU, Kshirsagar RV, Neve VA, D′souza SO. A prolonged observational study of tracheal tube displacements: Benchmarking an incidence <0.5-1% in a medical-surgical adult intensive care unit. Indian J Crit Care Med 2014; 18 (5):273-277.

DOI: 10.4103/0972-5229.132466

License: CC BY-ND 3.0

Published Online: 01-07-2005

Copyright Statement:  Copyright © 2014; The Author(s).


Abstract

Background and Aims: Tracheal tubes are commonly used in intensive care unit (ICU) and lead to complications like displacements. The primary aim of the study was to evaluate if the rate of tracheal tube displacement benchmarked at <1% per patient and <0.5% per tracheal tube day, could be sustained over a prolonged period. The secondary aim was to document the patterns of all forms airway accident and to evaluate their consequences. Subjects and Methods: This was a prospective observational study of Intubated and ventilated patients in a General Medical-Surgical Adult ICU. The incidence of accidental extubation, self extubation, partial displacement and blockages of tracheal tubes were recorded. Results: The overall tracheal tube displacement rate was 61/10,112 (0.6%) per patient and 61/28,464 (0.22%) per tracheal tube day. There were 30 additional incidents of blockage, kinking or biting of the tracheal tube. Physiological consequences-69 were mild, 10 moderate, 12 major and one death. Of the 91 accidents, 30 were partly and 30 were completely preventable. 76 incidents involved an endotracheal tube (54 displaced, 12 blocked and 10 bitten-kinked) and 15 a tracheostomy tube (seven displaced and eight blocked). Accidents were more common in medical than surgical patients (medical = 48, cardiac surgical = 17 and other surgical/trauma = 26). Conclusion: Tracheal tube displacement rate in a mixed medical-surgical adult ICU was maintained below the pre-set benchmark of <1% per patient and <0.5% per intubated day over nearly a decade.


PDF Share
  1. Kapadia FN, Bajan KB, Raje KV. Airway accidents in intubated intensive care unit patients: An epidemiological study. Crit Care Med 2000;28:659-64.
  2. Kapadia FN, Bajan KB, Singh S, Mathew B, Nath A, Wadkar S. Changing patterns of airway accidents in intubated ICU patients. Intensive Care Med 2001;27:296-300.
  3. Ripoll I, Lindholm CE, Carroll R, Grenvik A. Spontaneous dislocation of endotracheal tubes. Anesthesiology 1978;49:50-2.
  4. Smith RL, Planzos H. Unplanned extubation. Chest 1995;107:887-8.
  5. Coppolo DP, May JJ. Self-extubations. A 12-month experience. Chest 1990;98:165-9.
  6. Sessler CN. Unplanned extubations. Chest 1995;108:1769-70.
  7. Listello D, Sessler CN. Unplanned extubation. Clinical predictors for reintubation. Chest 1994;105:1496-503.
  8. Sessler CN, Glass C Grap MJ. Techniques for preventing and managing unplanned extubation. J Crit Illn 1994;9:609-19.
  9. Tindol GA Jr, DiBenedetto RJ, Kosciuk L. Unplanned extubations. Chest 1994;105:1804-7.
  10. Jayamanne D, Nandipati R, Patel D. Self extubation a prospective study. Chest 1988;94:3S.
  11. Seudal I, Garner CV, Kaye W. Accidental extubation in the ICU. Chest 1992;102:1843S.
  12. Brown R, Gau P, Touleimat B. Unplanned extubations in a community hospital. Chest 1992;102:183S.
  13. O′Neil K. A prospective study of unplanned extubations. Chest 1992;102:183S.
  14. Chiang AA, Lee KC, Lee JC, Wei CH. Effectiveness of a continuous quality improvement program aiming to reduce unplanned extubation: A prospective study. Intensive Care Med 1996;22:1269-71.
  15. Kapadia FN. Unplanned extubations. Chest 1995;108:1768-70.
  16. Rivera R, Tibballs J. Complications of endotracheal intubation and mechanical ventilation in infants and children. Crit Care Med 1992;20:193-9.
  17. Little LA, Koenig JC Jr, Newth CJ. Factors affecting accidental extubations in neonatal and pediatric intensive care patients. Crit Care Med 1990;18:163-5.
  18. Kapadia F. Unexpected endotracheal extubations. Lancet 1998;352:1633.
  19. Clinical Markers in Intensive Care. In: Determining the Potential to Improve the Quality of Care in Australian Health Care Organizations. Australian Council on Healthcare Standards. Health Services Research Group University of Newcastle; 2000. p. 52-4.
  20. Bouza C, Garcia E, Diaz M, Segovia E, Rodriguez I. Unplanned extubation in orally intubated medical patients in the intensive care unit: A prospective cohort study. Heart Lung 2007;36:270-6.
  21. Mion LC, Minnick AF, Leipzig R, Catrambone CD, Johnson ME. Patient-initiated device removal in intensive care units: A national prevalence study. Crit Care Med 2007;35:2714-20.
  22. Strüm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: A randomised trial. Lancet 2010;375:475-80.
  23. Jones C, Bäckman C, Capuzzo M, Flaatten H, Rylander C, Griffiths RD. Precipitants of post-traumatic stress disorder following intensive care: A hypothesis generating study of diversity in care. Intensive Care Med 2007;33:978-85.
  24. Agens JE. Chemical and physical restraint use in the older person. Br J Med Pract 2010;3:302.
  25. Chang LY, Wang KW, Chao YF. Influence of physical restraint on unplanned extubation of adult intensive care patients: A case-control study. Am J Crit Care 2008;17:408-15.
  26. Kapadia FN. Factors associated with blocked tracheal tubes. Intensive Care Med 2001;27:1679-81.
  27. Kapadia FN, Nath AS, Tekawade PP, Yadav A, Rane SA, Pachpute S, et al. Analysis of blocked tracheal tubes in ventilated ICU patients. Indian J Crit Care Med 2001;5:142-6.
  28. Kapadia F. Unplanned extubation in medical and surgical ICUs. Intensive Care Med 2004;30:2289.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.