Incidence and associated risk factors for airway Adverse events in intubated ICU patients At Muhimbili National Hospital

Abstract

Introduction Airway adverse events in intubated intensive care unit patients have been reported all over the world. The patterns of these events include Unplanned Extubation, Tube blocking, Endobronchial intubation, Tube kinking and leaking cuffs. However the most common ones are reported to be unplanned extubation and tube blocking. Low level of sedation and low number of ICU staff has been reported to play a role in unplanned extubation whereas prolonged intubation was associated with tube blocking among other factors. All these adverse airway events could lead to catastrophic effect to the patient since most of these patients had cardiopulmonary compromise. This was also accompanied by difficult airway management yet intervention was needed as soon as possible to minimize the effects. This study looked at the incidence, patterns, associated risk factors and the outcome of these airway adverse events. Methodology An observational prospective cohort study was conducted among intubated ICU patients atMuhimbili National Hospital. All intubated patients admitted to ICU were followed up after obtaining proxy consent from next of kin. A structured data collecting form which was updated every day during patient stay with endotracheal tube or tracheostomy tube was used. Patterns of airway adverse events plus associated complications were recorded from day of intubation till when the patient was extubated either due to improvement or death. Level of sedation, use of Humidifiers, Primary diagnosis, Physical restraints and technique used to secure the endotracheal tube plus numbers of tube days were also recorded. Results 98 patients with a total of 521 tube days were studied. There were overall 22 airway adverse events occurring in 22 patients with an incidence of 22.45% of patients and 4.22% / 100 tube days.The airway adverse events were 17.39% of patient and 3.40 %/100 tube days due to unplanned extubation and 6.52% of patients and 1.24%/ 100 tube days due to tube blockade.Unplanned extubation and tube blockade were the most common adverse events, no other airway adverse event were noted during a study period.Of the 22 adverse events majority of them did not get serious complications, apart from one case who sustained cardiac arrest following unplanned extubation. Conclusion and recommendations From this study it was noted that the overall incidence of 4.22%/100 tube days was quite highcompared to studies from other Intensive Care Units. Tube blockade and unplanned extubation were the commonly observed airway adverse events. This was contributed by inadequate staffduring night shifts, non routine use of Heat and Moisture Exchangers plus presence of auxiliary and less experienced staff in the units.We recommended training of critical care nurses and strict one nurse to one ventilated patient to be observed during all shifts.