Vagram Ovnanian

1083: RISK FACTORS ASSOCIATED WITH UNPLANNED EXTUBATIONS

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: Unplanned Extubations (UE) are associated with increased mortality and morbidity along with length of stay, and increased health care costs. The factors associated with unplanned extubations remain to be clearly defined. A better understanding of the risk factors leading to UE is essential for developing interventions to decrease the incidence of UE. The primary objective of this study was to establish risk factors associated with unplanned extubations. Secondary goals of the study were areas of improvement to decrease the total number of unplanned extubations. Methods: Seventy two unplanned extubations occurred between June 2012 and May 2017 at a single tertiary care academic center. The variables included in the primary analyses are age, gender, time of the day (categorised into 4 hour intervals) presence of restraints, the use of sedation (fentanyl, versed or propofol), and whether the patient was on a weaning protocol at the time of extubation (SBT). Primary analyses included univariate analysis such as linear regression for continuous variables and chi square for categorical variables associated with unplanned extubations. Results: Seventy two unplanned extubations occurred out of a total of 2667 mechanically ventilated patients (2.7%) during the study period. The study cohort consisted of 58% males with mean age of 67 years. Twenty one (29%) patients were undergoing a SBT at the time of self extubation. Thirty seven (51%) were continuously sedated while thirty (42%) were on restraints. In our cohort, increasing age was significantly associated with occurrence of UE (p-value = 0.0022). Even though, most of the UE occurred between 8 am and 12 noon (35%, p = 0.0027), sedation was decreased to perform spontaneous breathing trial. Conclusions: Our study shows that increasing age is a possible risk factor for unplanned extubation. Despite the UEs occurring on weekday mornings, it is confounded due to decreased sedation and occurrence of SBT. The limitations of the study include small sample size which preclude multivariate analyses. Our results may suggest that elderly population may be at higher risk of unplanned extubation and would benefit from dedicated supervision. Cautiously, we also recommend dedicated physician or nursing supervision to be performed during the SBT. Future studies are needed to identify high risk patients especially elderly to reduce the incidence of unplanned extubations.

1263: INTERVENTION FOR PREVENTION: REDUCING CATHETER-ASSOCIATED URINARY TRACT INFECTION IN THE ICU.

Crit Care Med 2016 • Volume 44 • Number 12 (Suppl.) that a rounding tool designed to reduce variability and promote best practices for lab and imaging utilization will cut costs and painful procedures, all while improving patient safety and comfort. Methods: We are conducting a cohort study with historic controls, examining effectiveness of a daily rounding checklist in reducing patient “pokes” defined as 1) painful procedures, labs and imaging studies and 2) IV/IM/SQ medications. We included all patients hospitalized in our 25-bed tertiary care PICU. In 2014 our PICU adopted a structured interdisciplinary bedside rounding model, which provided a platform for curbing overutilization. During a set time on rounds, the nurse reports how many “pokes” are anticipated that day and suggests ways to reduce them, followed by a team discussion of the proposed interventions. In addition we conducted an educational campaign and provided a lab pricing “menu” for resident physicians. Our primary outcome was the total number of “pokes” per patient per week. Secondary outcomes included utilization of individual lab and imaging tests and associated costs. Results: In a cohort of 2449 patients and 546 historic controls we observed a decrease in the total number of “pokes” from 21.5 to 19.7 per patient per week, p<0.012. Preliminary analysis of secondary outcomes revealed a decrease in metabolic panels for patients with status asthmaticus (1.70 to 1.19 per patient per day, p<0.0001), while individual potassium checks increased. For patients with hypo/hypernatremia, metabolic panels decreased from 2.06 to 1.73 per patient per day, p<0.0001, with a concomitant increase in individual sodium checks. Conclusions: A checklist tool within the structured interdisciplinary bedside rounding framework, decreased utilization of labs, imaging and painful interventions. Further analysis of ensuing reduction in patient harm and costs, is in progress.

813: PROTHROMBIN COMPLEX CONCENTRATE VERSUS STANDARD OF CARE IN WARFARIN-RELATED INTRACRANIAL HEMORRHAGE

Crit Care Med 2016 • Volume 44 • Number 12 (Suppl.) (p=0.06), total hospital length of stay (p=0.89), and maximum pain scores in 24 hours(p=0.19) or 48 hours (p=0.86). Based on our results we calculated a sample size of 75 for each arm for a power of 0.80. Conclusions: This retrospective chart review pilot study did not show any significant difference in pain management improvement with Exparel use. However, a future prospective randomized control study is planned based on our results and sample size calculation.