Risk factors associated with unplanned endotracheal self-extubation of hospitalized intubated patients: a 3-year retrospective case-control study

Chang, Li‐Chun; Liu, Pei Fen; Huang, Yu Lu; Yang, Shwu Huey; Chang, Wen Yin

doi:10.1016/j.apnr.2009.09.002

Cited by 51 publications

(60 citation statements)

References 14 publications

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“…Such extubation is associated with increased hospital and intensive care unit (ICU) lengths of stay and nosocomial pneumonia. [5][6][7] Many efforts to reduce the duration of mechanical ventilation specifically target decreasing untoward sequelae of the intervention or ensuring safe implementation of the therapy. Among these efforts are precautions to optimize mechanical ventilation to reduce complications such as ventilator-associated pneumonia and ventilator-induced lung injury.…”

mentioning

confidence: 99%

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

Tanios¹,

Epstein²,

Grzeskowiak³

et al. 2014

American Journal of Critical Care

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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.

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mentioning

confidence: 99%

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

Tanios¹,

Epstein²,

Grzeskowiak³

et al. 2014

American Journal of Critical Care

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show abstract

“…4,5 Balon reported that 80% of the patients in her study were restrained but less than one third had either an analgesic or sedative medication given intravenously within four hours of extubation. 6 She suggested that "as needed dosing" contributed to these events and that continuous infusions might be preferable.…”

Section: Discussionmentioning

confidence: 99%

A self-extubation case series in an ICU after the introduction of an early mobilization project

Tseng

Sigler²,

Edriss³

et al. 2014

SW Resp Crit Care Chron

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“…A explicação para essa situação pode ser o maior risco para delírio durante a noite, diminuição da luz e ausência de visitas de familiares, possivelmente combinadas com a diminuição da vigilância, por parte da equipe de enfermagem (Van Rompaey et al, 2009;Chang et al, 2011).…”

Section: Paulo Carlos Garciaunclassified

“…Além disso, um número desproporcionalmente alto de ENP (auto-extubação) parece ocorrer uma hora antes e uma hora após mudança de turno, o que implica na ausência das enfermeiras a beira leito e menos vigilância do paciente (Yeh et al, 2004;Chang et al, 2011).…”

Section: Paulo Carlos Garciaunclassified

“…Porém, uma explicação para essa ocorrência pode ser o risco de delirium durante o plantão noturno, associado à diminuição da luz, ausência de visita de familiares (Yeh et al, 2004;Van Rompaey et al, 2009;Inouye, Westendorp, Saczynski, 2014), combinadas, possivelmente, com a diminuição da vigilância, por parte da equipe de enfermagem (Chang et al, 2011 contribuir para a indicação da confusão aguda (delirium) ser um fator predisponente para a perda dos artefatos terapêuticos (Lôbo et al, 2010;Pereira et al, 2013).…”

Section: Caracterização Das Perdas Dos Artefatos Terapêuticosunclassified

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Correlação entre o tempo de assistência de enfermagem e indicadores de qualidade assistencial em Unidades de Terapia Intensiva

Garcia¹

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Risk factors associated with unplanned endotracheal self-extubation of hospitalized intubated patients: a 3-year retrospective case-control study

Cited by 51 publications

References 14 publications

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

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

A self-extubation case series in an ICU after the introduction of an early mobilization project

Correlação entre o tempo de assistência de enfermagem e indicadores de qualidade assistencial em Unidades de Terapia Intensiva

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