Abstract:
Background: Critically ill patients often require intubation for airway patency and mechanical ventilation in order to save their lives. Even though intubation is life-saving, it is also associated with many complications, such as self-extubation (SE). Currently, there is limited data on patients who have self-extubated in the emergency department in low- and middle-income countries. This study evaluated the risk factors of SE at the Centre Hospitalier Universitaire de Kigali (CHUK) in Kigali, Rwanda.
Methods: This cross-sectional study enrolled intubated patients at CHUK emergency department (ED) from 1st June 2020 to 28th February 2021. Trained study personnel collected data on demographics, clinical information, intubation characteristics, and medications. Cases consisted of all patients with occurrences of SE and were matched based on age, gender, and reason for admission and compared to intubated control patients who did not self-extubate. Patient characteristics of cases and controls were compared, and statistical differences were assessed using χ² or Fisher’s exact tests. Finally, a univariate logistic regression was employed to calculate odds ratios (ORs) with associated 95% confidence intervals (CIs).
Results: Over the study period, there was a total of 140 intubated patients, of which 34 (24%) self-extubated. The median age of all intubated patients was 37.5 years, with a male predominance (75.9%). The majority of SEs occurred during the night (58.82%). Self- extubation was associated with complications of hypoxia (50.00 %), aspiration (11.76%), and airway trauma (8.82%). Of those who SE, 15 (44.12%) were on a weaning process. Patients who were not sedated had higher odds of an occurrence SE compared to those who were sedated (OR=20.4, 95% CI 2.49 to 167.9, p=0.005). In addition, those in respiratory failure had higher odds of an event of SE compared to those who were not (OR=2.7, 95% CI 099-
7.33, p=0.05). There was no statistical difference in final ED disposition between the cases and controls.
Conclusion: In the population studied, there was high level of SE among intubated patients in emergency department which was associated with complications. These data may inform clinical guidelines for the prevention of SE and monitoring intubated patients in Rwanda and other similar ED settings
