Risk Factors For Unplanned Extubation Research Articles

Situations and Risk Factors of Unplanned Extubation of Nasogastric Tubes in Inpatients: A Retrospective Study.

The aim of the study is to understand whether the risk factors of the unplanned extubation (UE) of nasogastric (NG) tubes vary among different inpatient situations. Inpatients who experienced UE between 2009 and 2022 at a medical center were selected, and electronic medical records were used to collect patient background data and their conditions during UE. A total of 302 patients were included in our analysis. Conscious patients were at greater risk of UE when coughing, scratching their nose, blowing their nose, or sneezing than those who were confused (odds ratio [OR] = 0.07, P < 0.001) and those who were drowsy or comatose (OR = 0.15, P = 0.026). During activity, repositioning, bathing, or changing incontinence pads, the risk of UE was higher in patients whose hands were not restrained at the time of UE than in those whose hands were restrained (OR = 0.05, P = 0.004), higher in those with companions than in those without companions (OR = 7.78, P = 0.002), and higher in those with longer NG tube placement time (OR = 1.05, P = 0.008). Accidental extubation (OR = 2.62, P = 0.007) occurred more frequently during activity, repositioning, bathing, or changing incontinence pads. There is an increased risk of UE in conscious patients during activity, repositioning, bathing, or changing incontinence pads. Patients inserted with an NG tube for a longer period of time were at greater risk of accidental extubation during activity, repositioning, bathing, or changing incontinence pads irrespective of whether a companion could aid them if their hands were or were not restrained.

An Empirical Study of Feedforward Control in Unplanned Extubation of Nasogastric Tube.

To explore the effect of feedforward control on reducing the incidence of unplanned extubation and improving the quality of catheter nursing. A total of 186 patients with nasogastric tube after gastrointestinal surgery in the eastern region of our hospital from September 2020 to September 2021 were selected as the control group; 186 patients with nasogastric tube after gastrointestinal surgery in the western region of our hospital at the same period were selected as the experimental group. The influencing factors of unplanned extubation in patients with long-term postoperative nasogastric tube were analyzed, and effective preoperative and postoperative health education was conducted. The ratio of unplanned extubation of nasogastric tube and nursing satisfaction of patients in the two groups were compared. Patient constraint, perceived pressure score, anxiety score, nasal gastrointestinal canal health education feedback score and indwell tube comfort score were independent risk factors for unplanned extubation. The restraint rate and the incidence of unplanned extubation in the experimental group were lower than those in the control group after intervention, with statistical significance (P < 0.05). The nursing satisfaction of the experimental group was significantly higher than that of the control group after feedforward cognitive intervention. After intervention, serum albumin and gastric PH in the experimental group were significantly higher than those in the control group (P < 0.05). The safe nursing management method of feed forward control can effectively reduce the incidence of unplanned extubation in inpatients, which is worth further promoting in nursing work.

Unplanned extubations in the adult intensive care units

Patients require admission to intensive care unit with endotracheal intubation and mechanical ventilation for various reasons. It can last for a short duration or could be prolonged. The endotracheal tube is removed once the underlying problem is resolved and is called planned extubation. Sometimes extubation occurs unintentionally and is called unplanned extuabtion. Unplanned extubation could be accidental or self extubation. There is a potential risk of unplanned extubation as long as the patient remains intubated. As unplanned extubation can lead to catastrophic events, it is ideal to have a weaning protocol in place so that the patients are extubated as soon as they satisfy the extubation criteria. This CME article mainly focuses on the risk factors for unplanned extubation in the adult intensive care unit and the complications associated with it. The strategies for prevention of unplanned extubation has been highlighted at the end.

Planned Versus Unplanned Extubation in Opioid Overdose Patients: Does it Have any Effect on the Prognosis? A Cohort Study

Background: Tracheal intubation is a life-saving measure in patients poisoned acutely with opioid, and when naloxone treatment is inadequate. This study determined the risk factors for early unplanned extubation in these patients and evaluated the effects on the clinical outcomes. Methods: At a poisoning center in Tehran, Iran, 165 opioid overdose patients who were admitted to the intensive care unit and intubated between September 2019 and March 2020 were enrolled into this study. Patients were categorized in two groups: a) those extubated based on the physicians’ decision, and b) those who were extubated by self or were accidentally. The two groups were compared regarding their clinical outcomes and complications during hospitalization. In addition, the re-intubated patients in both groups were compared to those with successful intubation regarding the predisposing factors and mortality. Results: Of these patients, 36 (21.8%) died before extubation, and planned extubation was performed in 109 of them (84.5%). Unplanned extubation occurred in 20 patients (15.5%). Agitation, elevated temperature (&gt;38.5ºC), and insufficient nursing care were the independent risk factors for the unplanned extubation. 6(5.5%) and 3(15%) patients died following the planned and unplanned extubation, respectively, and 24 patients required reintubation. Patient transfer, succinylcholine use, aspiration pneumonia, presence of brain injury, and insufficient nursing care were independent risk factors for re-intubation. Conclusion: Among the patients with high drug dependency, higher doses of sedatives were needed to avoid self-extubation. Infection control and sufficient nursing care were factors that led to better clinical outcomes for extubation in these patients.

Airway misadventures in adult critical care: a concise narrative review of managing lost or compromised artificial airways.

Loss or compromise of artificial airways in critically ill adults can lead to serious adverse events, including death. In contrast to primary emergency airway management, the optimal management of such scenarios may not be well defined or appreciated. Endotracheal tube cuff leaks may compromise both oxygenation and ventilation, and supraglottic cuff position must first be recognized and distinguished from other reasons for gas leakage during positive pressure ventilation. Although definitive management involves tube exchange, if direct visualization is possible temporizing measures can often be considered. Unplanned extubation confers variable and context-specific risks depending on patient anatomy and physiological status. Because risk factors for unplanned extubation are well established, bundled interventions can be employed for mitigation. Tracheostomy tube dislodgement accounts for a substantial proportion of death and disability related to airway management in critical care settings. Consensus guidelines and algorithmic management of such scenarios are key elements of risk mitigation. Management of lost or otherwise compromised artificial airways is a key skill set for adult critical care clinicians alongside primary emergency airway management.

Risk factors for unplanned extubation in ventilated neonates in South Korea

PurposeAlthough unplanned extubation (UE) is a common occurrence in neonatal intensive care units (NICUs), the factors influencing UE have not been clearly identified in South Korea. Therefore, we investigated the incidence of UE along with its risk factors among neonates in the NICU. Design and methodsThis retrospective cohort study was conducted in a single NICU in B city. The electronic medical records of 137 ventilated neonates admitted between January 2017 and June 2018 were analyzed using an audit tool on extubation. Kaplan–Meier estimation and univariate and multivariate Cox proportional hazards models were used for statistical analyses. ResultsThe rate of UE was 32.1%, with an incidence of 6.56 per 100 ventilation days during the 18-month study period. Risk factors for UE were the use of sedatives or analgesics; no re-fixation of the endotracheal tube (ETT); suction frequency; a high nurse–patient ratio; and working night shifts (weekdays 5 p.m. to 8 a.m.), weekends, or holidays. ConclusionsThe rate of UE among neonates was found to be considerably higher than that of other countries. Among the various factors, nursing-related factors were most commonly associated with the risk of UE. Application to practiceVarious prevention strategies, including complete ETT fixation, maintaining ETT placement, a low nurse–patient ratio, and close observation of the ETT may help reduce UE in the NICU.

Unplanned extubations in an intensive care unit: Findings from a critical incident technique

BackgroundPatients on mechanical ventilation are at risk of experiencing a potentially life-threatening unplanned extubation in the intensive care unit, which can lead to arrhythmias, bronchial aspiration, difficulty in reintubation or even sudden cardiac arrest. Although incidence and outcomes of the phenomenon have been documented in several quantitative studies, no studies have investigated the antecedents as experienced by critical care nurses. ObjectivesTo gain a greater understanding of the antecedents of unplanned extubations. MethodsA qualitative study design involving the critical-incident technique. A total of 10 registered nurses who reported one or more episodes of unplanned extubations were involved in an in-depth interview. FindingsAccording to the nurses’ experience, episodes of unplanned extubations are determined by predisposing, precipitating and mediating factors. The predisposing factors have been recognised in the (a) weaning programme (expected/unexpected decreased sedation) and in the (b) patient factors (increased needs due to discomfort, restlessness and desire to communicate). The precipitating factors have been divided into (a) organisational (failures in multi-professional communication), (b) environmental (excessive environmental chaos and barriers preventing direct surveillance) and (c) nursing care factors (ensuring privacy by creating barriers, avoiding disturbing other patients and poor nurse-to-patient ratio). Among the mediating factors, which are affected by the precipitating factors, decreased surveillance and mechanical restraints’ use have been identified. ConclusionIdentifying risk factors of unplanned extubation, specifically those that are modifiable, such as increasing interprofessional communication, reducing excessive environment chaos, implementing strategies aimed at overcoming barriers threatening direct surveillance and ensuring appropriate nurse-to-patient ratio, can prevent the occurrence of these events.

Use of electronic critical care flow sheet data to predict unplanned extubation in ICUs

This study utilized critical care flow sheet data to develop prediction models for unplanned extubation. A total of 5180 patients with 5412 cases of endotracheal tube extubation treated in a tertiary care teaching hospital were evaluated. A total of 60 extubation cases were classified as unplanned, and 5352 as planned. Features documented in the critical care flow sheet for the 24 h prior to extubation were grouped into those with recording frequencies ≤3 and >3. The nearest values to the extubation were identified for all features. For features recorded >3 times, the maximum, minimum, mean, and recording frequencies were calculated. Univariate analyses were performed to select features for inclusion in multivariate analyses. Three multivariate logistic regression models were compared. Model 1 contained only the nearest value, Model 2 added a recording frequency, and Model 3 replaced the nearest value with the maximum, minimum, or mean that had the highest effect size for each feature recorded >3 times.Univariate analyses showed that 18 features differed significantly between the unplanned extubation and control groups. These included vital signs (e.g., pulse and respiration rates, body temperature), ventilator parameters (e.g., minute volume, peak pressure), and consciousness indicators (e.g., Glasgow coma scale score, Richmond agitation sedation scale score, motor power). On all three multivariate analyses, the Glasgow coma scale score, pulse rate, and peak pressure were statistically significant. The frequency of patient positioning (Model 2) and the minimum respiration rate (Model 3) were also significant. Area under the curve, sensitivity, and positive and negative predictive values improved slightly from Model 1 to Model 2 and from Model 2 to Model 3.This study found that minute volume, peak pressure, and motor power are significant risk factors for unplanned extubation that have not been previously reported. Recording frequency, which reflects how often nursing activities were provided, was also a useful predictor. The indicators identified in this study may help to predict and prevent unplanned extubation in clinical settings.

Systematic evaluation of risk factors of unplanned extubation associated with peripherally inserted central catheters among cancer patients

Objective To assess the risk factors of unplanned extubation associated with peripherally inserted central catheters(PICC) among cancer patients, and to provide theoretical basis for unplanned extubation associated with PICC among cancer patients. Methods We searched the related papers from the Cochrane Library, PubMed, EMbase, CINAHL, CBM, WanFang Data, CNKI and VIP.The data were extracted according to the inclusion and exclusion criteria by two reviewers, the quality of included studies was also evaluated.Meta-analysis was conducted using RevMan 5.3 or only descriptive analysis was conducted instead. Results Six studies were included in the study.The sample size was 3 463 with 233 cases in unplanned extubation group and 3 230 cases in control group.The incidence rate of unplanned extubation associated with PICC was 6.7%.Meta-analysis showed that the relevant factors were thrombosis and drug. Conclusions The risk factors of unplanned extubation with PICC among cancer patients are thrombosis and drug(high concentration nutrition). Key words: Neoplasms; Peripherally Inserted Central Catheter; Unplanned extubation; Risk factor

Case-control Study on Risk Factors of Unplanned Extubation Based on Patient Safety Model in Critically Ill Patients with Mechanical Ventilation

This study aimed to identify risk factors of unplanned extubation in intensive care unit (ICU) patients with mechanical ventilation using a patient safety model. This study was designed to be a case-control study. Data collection sheets, including 29 risk factors of unplanned extubation in mechanically ventilation patients were retrospectively collected based on a patient safety model over 3 years. From 41,207 mechanically ventilated patients, 230 patients were identified to have unplanned extubation during their ICU stay. Based on the characteristics of the cohort of 230 patients who had unplanned extubation, 460 case control comparison groups with planned extubation were selected by matching age, gender and diagnosis. Risk factors of unplanned extubation were categorized as people, technologies, tasks, environmental factors and organizational factors, by five components of the patient safety model. The results showed the risk factors of unplanned extubation as admission route [odds ratio (OR)=1.8], Glasgow Coma Scale-motor (OR=1.3), Acute Physiology and Chronic Health Evaluation score (OR=1.06), agitation (OR=9.0), delirium (OR=11.6), mode of mechanical ventilation (OR=3.0-4.1) and night shifts (OR=6.0). The significant differences were found between the unplanned and the planned extubation groups on the number of reintubation (4.3% vs. 79.6%, p<.001), ICU outcome at the time of discharge (χ2=50.7, p<.001), and length of stay in the ICU (27.0±33.0 vs. 43.8±43.5) after unplanned extubation. ICU nurses should be able to recognize the risk factors of unplanned extubation related with the components of the safety model so as to improve patient safety by minimizing the risk for unplanned extubation.

The Assessment of the Risk of Unplanned Extubation in an Adult Intensive Care Unit.

In order to plan and implement nursing intervention to reduce the incidence rate of unplanned extubation problem in the intensive care unit (ICU), it is necessary to determine the risk factors of unplanned extubation and the patients under risk. This study was undertaken with the aim of evaluating the risk of unplanned extubation of endotracheal tube in adult ICU. This was a case-control study. The population constituted patients hospitalized in the adult ICU during 1-year period in a university hospital. The sample from this population was composed of patients whose extubation was unplanned (30 patients) and the randomly selected patients (60 patients) who were intubated at the same time in the ICU for each patient whose extubation was unplanned. In data collection, the Richmond Agitation-Sedation Scale, Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II were utilized. According to the findings, the variables such as sex, age, mechanical ventilation period, and Acute Physiology and Chronic Health Evaluation II and Glasgow Coma Scale scores did not have any effect on the unplanned extubation, but variables such as internal medicine diseases and Richmond Agitation-Sedation Scale did have an effect. It was also revealed that there was no extubation plan in most of the unplanned extubation group, the nurse was anticipating the unplanned extubation, the patient was intubated again, and a complication occurred. The patients who are provided inadequate sedation and analgesia and who have problems in their respiratory system are under risk of unplanned extubation. In order to prevent unplanned extubation, an adequate amount of sedation and private nursing care should be provided to patients in the ICU.

Influence of sedation strategies on unplanned extubation in a mixed intensive care unit.

Identifying risk factors for unplanned extubation in patients receiving mechanical ventilation can help guide prevention strategies. To assess the risk of unplanned extubation with different sedation strategies. A 36-month quality improvement study in a 33-bed intensive care unit at a tertiary-care center. A total of 92 unplanned extubations occurred (7.5 events/1000 days of mechanical ventilation): patients who were receiving continuous sedation protocol with daily interruption of sedatives had 1.5 events/1000 ventilator days, patients receiving the intermittent sedation protocol had 5.0 events/1000 days, and patients with no sedation protocol had 16 events/1000 days (P < .05). Median duration of mechanical ventilation before unplanned extubation was 2 days. Most unplanned extubations (94%) were deliberate, and 53% occurred in patients scheduled for weaning. Most unplanned extubations in the continuous sedation protocol group (71%) occurred during weaning, in comparison to the intermittent sedation protocol (54%) and no sedation protocol groups (48%, P< .05). The highest incidences of agitation were in patients receiving the intermittent sedation protocol as compared with the other 2 groups (77% vs 50% vs 49%, P < .05). Overall, 73% of patients who had an unplanned extubation did not require reintubation; those who did were older (mean age: 68 vs 53 years, P = .01) and were male (80% vs 20%, P= .02). Reintubation was unrelated to the time of unplanned extubation. Strategies of no sedation or intermittent sedation are both associated with higher rates of unplanned extubation when compared to a strategy of continuous sedation with daily interruption of sedatives. Sedation strategies that allow agitation may increase the risk of unplanned extubation.

Unplanned extubation in critically ill adults: clinical review

To investigate and synthesize the evidence on the incidence and consequences of unplanned extubation (UE) in intensive care unit (ICU) patients, and on risk factors for UE. ICU patients generally spend considerable time being intubated via the endotracheal route. Non-planned endotracheal tube removal, either deliberate or accidental, may pose significant safety risks for them. As UE is among the most studied critical incidents in the ICU, evaluation and summary of existing findings could provide important implications for clinical practice. SEARCH STRATEGIES, INCLUSION AND EXCLUSION CRITERIA: Observational studies published between 1990 and 2012 in English-language journals indexed by Cumulative Index for Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science and the Cochrane Library were searched for studies on UE of critically ill adults. Thirty-three articles were considered eligible for inclusion. UE incidence varies considerably among reports, with self-extubation representing the majority of cases. Agitation, especially when combined with inadequate sedation, and decreased patient surveillance are the major risk factors for UE. Inexperienced personnel and improper tube fixation may also be important, while physical restraint use remains controversial. UE can be followed by serious complications, mainly aspiration, laryngeal oedema and increased risk for pneumonia. Need for re-intubation is a major determinant of patient outcomes. Implementation of educational or quality improvement programs is expected to advance personnel's knowledge about risk factors for UE, promote skills on safe, standardized procedures for patient care and increase compliance with them. Identifying risk factors for UE and minimizing UE incidence through appropriate preventive strategies are prerequisites for improving nursing care quality and patient safety in the ICU.

Risk factors for unplanned extubation in critically ill patients

Unplanned extubation (UE) is a frequent complication in ICU patients associated with increased morbidity, mortality, duration of mechanical ventilation, ICU stay and hospital stay. Although UE has been studied, still not much is known on the incidence, determinants and outcome. The aim of the study was to assess the incidence and determinants of UE in a tertiary-care ICU.

Reducing Accidental Extubation in Neonates

Unplanned or accidental extubations (UPEs) showed little improvement until the clamp method of fixation of endotracheal tubes was selected.

Unplanned extubation in the ICU: Impact on outcome and nursing workload

PURPOSE: To determine the incidence and factors associated with unplanned extubation (UE) in the intensive care unit (ICU) and its relationship with nursing workload. MATERIALS AND METHODS: A retrospective case-control study was carried out within a cohort of ventilated patients in two teaching hospital medical-surgical ICUs. A total of 50 adult patients with UE were studied. Controls were subjects without UE who were matched to the cases on the following Five factors: age, gender, admission diagnostic category, admission date (within 3 months) and duration of mechanical ventilation. Other data including patient demographics, comorbid conditions, APACHE III score, ventilation parameters, use of sedation, re-intubation, mortality rate and ICU/hospital length of stay were collected. Nine equivalents of nursing manpower use score (NEMS) and multiple organ dysfunction score (MODS) were calculated in both, cases and controls, 24 h before and after the event. RESULTS: Sixty-eight episodes of UE occurred in 66 patients during the 24-month study period (1.1%). Patients with UE were more agitated ( P 0.05). The mean NEMS were not significantly different between the two groups 24 h before ( P =0.69) and after ( P =0.99) the extubation event. Also, the mean MODS were similar between both groups 24 h before ( P =0.69) and after ( P =0.74) extubation. CONCLUSION: In this study, agitation and greater use of benzodiazepines were frequently associated with UE and potentially can be used as risk factors for UE. We have found no significant impact of UE on increasing mortality and, in a manner not shown before, nursing workload.

Unplanned extubation in the intensive care unit

A 1-month prospective quality improvement audit was performed to determine the incidence of self-extubation in the intensive care units (ICUs) at the Westchester County Medical Center (WCMC), a 625-bed tertiary care hospital with 92 intensive care beds in 11 ICUs. During the 1-month study period, there were seven unplanned extubations in six of 121 intubated patients, or one unplanned extubation for every 136 patient-ventilator days. Based on the initial review, a corrective action plan was initiated that consisted of education of nurses and house staff about the problem of unplanned extubation, daily assessment on rounds of patient risk of unplanned extubation, and careful documentation of any episodes of unplanned extubation. A 5-month follow-up review identified 12 unplanned extubations in 11 patients, which resulted in a reduced rate of one unplanned extubation per 455 patient-ventilator days. Risk factors for unplanned extubation included documented anxiety, routine care intervention, and a history of previous unplanned extubation. Unplanned extubation can be a serious complication associated with mortality and therefore is a quality-of-care concern. However, the majority of patients with this complication did well and were discharged from the hospital. The incidence of unplanned extubation can be reduced but not eliminated by a program of education and attention to risk factors for unplanned extubation.