Unplanned Extubation as a Prognostic Factor in Critically Ill Patients: A Systematic Review and Meta-analysis

Abstract

A BSTRA CT BACKGROUND Although the majority of medical professionals recognize unplanned extubation as a critical accident, its relationship with the clinical outcomes of ventilated patients is controversial. The purpose of this study was to understand whether unplanned extubation, including self-extubation and accidental extubation, is a prognostic factor for clinical outcomes of mechanically ventilated adult patients. METHODS A pre-specified protocol was registered on PROSPERO (CRD42019120976). EMBASE, MEDLINE, CINAHL, and the ICTRP were searched on December 25, 2018 and February 5, 2020. The primary outcome was hospital mortality, and the secondary outcomes were ICU mortality, ICU and hospital length of stay, duration of mechanical ventilation, proportion of reintubation, and cost. RESULTS Of the 3216 articles retrieved, 11 were selected for the systematic review, and 9 met the criteria for the meta-analysis. Self-extubation was significantly associated with lower hospital mortality (OR = 0.49, 95% CI 0.30-0.81; certainty of evidence: moderate) and unplanned extubation was associated with ICU mortality (OR = 0.34, 95% CI 0.17-0.69; certainty of evidence: moderate). There were no significant between-group differences in lengths of hospital or ICU stay, with mean differences of 1.71 days (95% CI −7.68 to 11.69; certainty of evidence: very low) and 1.26 days (95% CI −3.58 to 6.10; certainty of evidence: very low), respectively. CONCLUSIONS Self-extubation is associated with lower patient mortality, but a definitive conclusion cannot be made due to methodological limitations.