Unplanned Endotracheal Extubation Research Articles

Effectiveness of a continuous quality improvement program aiming to reduce unplanned extubation: a prospective study.

To evaluate the effectiveness of a continuous quality improvement (CQI) program in reducing the incidence of unplanned endotracheal extubation. Prospective study over a 9-month period. Adult intensive care units (ICUs including coronary care unit, medical ICU, surgical ICU, and cardiovascular surgical ICU) in a university-affiliated medical center. 831 consecutive mechanically ventilated patients. CQI program focusing on standardization of procedures, improvement of communication, and identification and management of high-risk patients. With the implementation of this CQI program, the overall incidence density of unplanned extubation (defined as number of new unplanned extubations per mechanical ventilation patient-days) significantly decreased from 2.6% in the first trimester to 1.5% in the second trimester and 1.2% in the third trimester (p = 0.01). This reduction was essentially the result of a decrease in unplanned extubation in orally intubated patients (incidence density 4.6, 1.7 and 1.0% for three trimesters, respectively; p < 0.0001). Unplanned extubation in nasally intubated patients remained largely unaffected (1.2, 1.4, and 1.4% for three trimesters, respectively; p = 0.92). The implementation of a concerted CQI program is effective in reducing the overall incidence of unplanned endotracheal extubation.

Unplanned endotracheal extubation in the intensive care unit

Study Objective: To identify the frequency, outcome, and factors associated with unplanned endotracheal extubation (UE) in the intensive care unit (ICU). Design: Prospective study. Setting: An urban, university trauma-surgical ICU. Patients: 96 intubated ICU patients who underwent 101 episodes of UE. Interventions: Patient, nursing, respiratory, and demographic factors associated with UE and patient outcome were determined for one year. Results were presented to nursing staff. The incidence of UE as a function of the total number of ventilator days was determined for one year post nursing education. Endpoints: Patients with UE were identified. Patients with reintubation were followed until final extubation. Measurements and Main Results: 85% of UE were self-extubations and 15% were accidental. Self-extubations occurred with equal frequency during all three nursing shifts in alert or agitated patients who were not being weaned. Accidental extubations occurred during the day shift in less alert patients and were associated with transport procedures and the use of rotary beds. Overall, 57% of patients were reintubated and most reintubations were in the first hour. Difficulty with reintubation was common, and one patient who could not be reintubated died. There were significantly fewer UE per ventilator day after nursing education. Conclusions: Patients should be observed closely after unplanned extubation, although many may not require reintubation. Reintubation can be quite difficult, necessitating highly shitted airway management. Attention to associated risk factors may decrease the incidence of both accidental and self-extubation.