Airway accidents in intubated intensive care unit patients: An epidemiological study

Objective: To assess the rate of occurrence and nature of airway accidents in intubated patients. Design: Prospective recording of all airway accidents in a 16-bed multidisciplinary intensive care unit. Patients: A total of 5,046 ventilated patients intubated for 9,289 days during 4 yrs. Measurements and Main Results: We determined the number and diagnoses of intubated and ventilated patients, the number and timing of airway accidents, the type of tracheal tube used and duration for which the tube was in situ, the description of the type of accident, the severity of the accident, and its impact on the course of the patient's illness, whether the patient needed reintubation, and whether the accident was preventable. The total accident rate was 36 of 5,046 patients during 9,289 intubated patient days; 26 occurred in 5,043 endotracheally intubated patients during 8,446 patient endotracheal tube days. There were 10 tracheostomy-related accidents from a total of 79 patients with tracheostomies during 843 tracheostomy patient days. Six had severe consequences and one resulted in death. Eleven were completely preventable, 17 partly preventable, and 8 were considered unpreventable. Self-extubation was the most common accident, Seven of 13 self extubations occurred in patients due for elective extubation in the next few hours. Twelve of 15 patients with self- or accidental extubation of an endotracheal tube accidents did not require reintubation. Conclusions: Airway accidents occurred at low levels with even lower rates of resultant morbidity and mortality. Tracheostomy accidents are more common than those with an endotracheal tube.