Risk factors and outcomes after unplanned extubations on the ICU: a case-control study

Crit Care. 2011;15(1):R19. doi: 10.1186/cc9964. Epub 2011 Jan 13.


Introduction: Unplanned extubation (UE) is a frequent event during mechanical ventilation in critically ill patients and might be associated with increased morbidity and mortality. However, detailed knowledge of risk factors and outcomes after UE is lacking.

Methods: A case-control study was performed with a case to control ratio of 1:4. Incidence density sampling was applied. Seventy-four cases and 296 control patients were included.

Results: Seventy-four UEs occurred in 69 patients, comprising 2% of all mechanically ventilated patients. Multivariable regression analysis revealed that the first and second categories of the Ramsay Sedation Scale score were associated with a high risk for an UE (odds ratios (ORs) 30 and 25, respectively). Male sex, subunit of the intensive care unit (ICU), length of stay in the ICU and midazolam use at time of UE were also risk factors for an UE. Patients with an UE had lower hospital mortality than mechanically ventilated patients without UE, 10% versus 30%, respectively. Forty-seven percent (n = 35) of the patients with an UE had to be reintubated.

Conclusions: The present study shows that the first and second categories of the Ramsay Sedation Scale were associated with a high risk for an UE. Also, male sex and use of midazolam at time of UE were identified as risk factors for an UE. However, compared with mechanically ventilated controls, no increased mortality was shown for UE patients. In UE patients without the need for subsequent reintubation, mortality was very low.

MeSH terms

  • Aged
  • Airway Extubation*
  • Case-Control Studies
  • Device Removal*
  • Female
  • Hospital Mortality*
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Intubation, Intratracheal / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Male
  • Midazolam / therapeutic use
  • Middle Aged
  • Prospective Studies
  • Respiration, Artificial*
  • Risk Factors
  • Sex Factors
  • Treatment Outcome


  • Midazolam