Influence of Sedation Strategies on Unplanned Extubation in a Mixed Intensive Care Unit

Abstract

A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Define unplanned extubation. 2. Explain possible causes of unplanned extubation. 3. Identify the relationship between sedation strategy and unplanned extubation. Results 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. Conclusion 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.

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

“…This study focused on the five component of nurses' working system in the ICU, which demonstrated a correlation with unplanned extubation [20]. In conclusion, multiple significant risk factors for unplanned extubation in the ICU working system cause negative outcomes pertaining to critical care, and systems engineering initiation for the ICU patients' safety should be considered more carefully in critical care nursing [21].…”

Unplanned extubation: securing the tool of our trade

“…For example, a discussion about ETT position and fixation, and about ventilation strategy and anticipated extubation, should be included as part of a daily patient risk assessment, and ward round checklists have been shown to ensure this is done with beneficial effects on UE rates [4]. Optimal sedation strategy could impact UE rates and must be carefully orchestrated in intubated patients [5]. It is important to determine whether a change in workflow could contribute to UE.…”

Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units

“…This finding is consistent with previous report in neonate that UE rate can be reduced with process standardization and frontline staff education, emphasizing vigilant ETT maintenance. [16] Tanios et al [23] reported on the different effects of various sedation strategies on UE in a mixed ICU. Their findings that a strategy of continuous sedation with a daily interruption of the sedative was associated with a lower rate of UE than was no sedation or intermittent sedation.…”