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Unplanned extubation in critically ill adults: clinical review
Author(s) -
Kiekkas Panagiotis,
Aretha Diamanto,
Panteli Eleftheria,
Baltopoulos George I,
Filos Kriton S
Publication year - 2013
Publication title -
nursing in critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.689
H-Index - 43
eISSN - 1478-5153
pISSN - 1362-1017
DOI - 10.1111/j.1478-5153.2012.00542.x
Subject(s) - medicine , cinahl , intensive care medicine , intensive care unit , patient safety , cochrane library , observational study , incidence (geometry) , medline , sedation , intensive care , emergency medicine , intubation , medical emergency , nursing , health care , psychological intervention , randomized controlled trial , surgery , physics , pathology , political science , optics , economics , economic growth , law
Aims and objectives: 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. Background: 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. Conclusions: 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. Relevance to clinical practice: 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.