Self-Extubation in Patients with Traumatic Head Injury: Determinants, Complications, and Outcomes

Background: Self-extubation is a common clinical problem associated with mechanical ventilation in trauma patients worldwide.

Objectives: This study aimed to evaluate the predisposing factors, complications, and outcomes of self-extubation in patients with head injury.

Methods: This was a retrospective cohort study.

Settings: The study was conducted in a trauma intensive care unit (TICU).

Patients: All intubated patients with head injury admitted to TICU between 2013 and 2015 were included in the study.

Interventions: Planned compared to selfextubation during weaning from sedation.

Measurements: Risk, predictors, and outcomes of self-extubation were measured.

Main results: A total of 321 patients with head injury required mechanical ventilation, of which 39 (12%) had self-extubation and 12 (30.7%) had reintubation. The median Glasgow Coma Scale, head abbreviated injury score, and injury severity score were 9, 3, and 27, respectively. The incidence of self-extubation was 0.92/100 ventilated days. Self-extubated patients were more likely to be older, develop agitation (P = 0.001), and require restraints (P = 0.001) than those who had planned extubation. Furthermore, self-extubation was associated with more use of propofol (P = 0.002) and tramadol (P = 0.001). Patients with self-extubation had higher Ramsay sedation score (P = 0.01), had prolonged hospital length of stay (P = 0.03), and were more likely to develop sepsis (P = 0.003) when compared to the planned extubation group. The overall in-hospital mortality was significantly higher in the planned extubation group (P = 0.001). Age-adjusted predictors of self-extubation were sedation use (adjusted odds ratio [aOR]: 0.06; P = 0.001), restraint use (aOR: 10.4; P = 0.001), and tramadol use (aOR: 7.21; P = 0.01).

Conclusions: More than one-tenth of patients with traumatic head injury develop self-extubation; this group of patients is more likely to have prescribed tramadol, develop agitation, and have longer hospital length of stay and less sedation use. Further prospective studies are needed to assess the predictors of self-extubation in TICU.