[Unplanned extubations in adult intensive care units: an update]

Abstract

Introduction: Unplanned extubations (UEs) in adult Intensive Care Units (ICUs), have recently become an indicator of quality and safety of care.

Method: A literature review published 10 years ago was updated to analyze any changes in UEs.

Results: The cumulative incidence of UEs varied between 0.3% and 27%, before 2000, and more recently, from 0.5% to 35.8%, without substantial changes. The rate of Self Extubations (SE) outweighed the Accidental Extubation (AE), amounting to 50%-100% of all UE. The reintubations rate ranged between 1.81% and 88%. The UEs increase the length of the mechanical ventilation, of ICU and hospital stay, and according to few studies the rate of death with UEs is lower. Major risk factors for UE are: APACHE II score ≥17, agitation, physical restraints, administration of midazolam, and higher levels of consciousness. The implementation of ABCDE bundle in ICUs did not involve additional risks of UE. The prevention includes a sedation with drugs different from benzodiazepines, an early detection of patients' readiness to weaning trial from mechanical ventilation, and the adequate stabilization of the endotracheal tube, with securing systems passing behind the patient's neck. The use of physical restraints is inconsistent, since it can be a risk factor for SE.

Conclusions: For preventing UEs the surveillance of nursing staff is fundamental, if the staffing is adequate to the real workloads in ICU.