Incidencia de retirada no programada de dispositivos invasivos en enfermos con COVID-19 en cuidados intensivos

Abstract

Introduction

The rate of unscheduled removal of invasive devices (ID) is an indicator of quality programmes in the critically ill. Our research group performed prevalence analyses since 2010 and another during the pandemic. The aim was to analyse the rates of use and non-planed removal of endotracheal tubes, catheters (central venous and arterial) and enteral catheters in the first wave of the COVID-19 pandemic comparing them with previous rates.

Methodology

Prevalence study in a polyvalente ICU. After 4 prospective observational analyses (2010, 2011, 2018, 2019) a retrospective analysis was performed (8 March-8 May 2020). Variables: diagnosis, stay and reason for removal of ID (endotracheal tubes (ET), central venous catheters, arterial catheters and enteral catheters) and rate of reintubation after self-removal of ET. Variables analysed and described as accidental removal rates per 1000 device-days and rates of ID use.

Results

2026 patients were included (631 in 2010, 724 in 2011, 210 in 2018, 361 in 2019 and 100 in 2020). Significant differences, between all periods, in diagnoses (P<.001), ICU stay (P<.001) and mortality (P=.016) and, between 2020 and all other periods, in rates of use per 100 days-stay (P<.010) and per 100 admissions (P<.001) in all devices except arterial catheter. In 2020, there was an increase in ET obstruction (36.0%; rate 20.27 per 1000 intubation/days, P<.010), decrease in ET self-removals (2020 rate: 0.00 per 1000 intubation/days; P<.050) and enteral catheters (14.33 per 1000 catheter/days). Overall reintubation (all periods) after self-extubation: 12.5%.

Conclusions

The rate of devices self-removal in COVID-19 patients in the first wave of the pandemic was lower than that observed in the previous four periods. The high incidence rate of ET obstruction in these patients was significant and relevant.