Skip to main content

You must be logged in to purchase this course.

Existing users login here | New users register here

Unplanned Extubation: An Underrecognized Complication

An unrecognized dislodgment of an endotracheal tube can cause major complications.  The objectives for this training include to: identify the circumstances and consequences of unplanned extubation, outline evidence-based interventions for cases of unplanned extubation, and describe preventive strategies for secure tube placement.

Objectives

  • Identify the circumstances and consequences of unplanned extubation
  • Outline evidence-based interventions for cases of unplanned extubation
  • Describe preventive strategies for secure tube placement

References

1. Ismaeil MF, El-Shahat HM, El-Gammal MS, Abbas AM. Unplanned versus planned extubation in respiratory intensive care unit, predictors of outcome. Egyptian J Chest Dis Tuberculosis, 2014 Jan; 63(1): 219–31.

2. Yoon HK, Park HS, Park HP. Clinical outcomes after unplanned extubation in a surgical intensive care population: reply. World J Surg, 2014; 38(8): 2,191.

3. Thiel D, Houten J, Wecksell M. Accidental tracheal extubation of a patient in the prone position. A A Case Rep, 2014; 2(2): 20–2.

4. Moons P, Boriau M, Ferdinande P. Self-extubation risk assessment tool: predictive validity in a real-life setting. Nurs Crit Care, 2008; 13(6): 310–4.

5. de Groot RI, et al. Risk factors and outcomes after unplanned extubations on the ICU: a case-control study. Crit Care, 2011; 15(1): R19.

6. da Silva PS, Fonseca MC. Unplanned endotracheal extubations in the intensive care unit: systematic review, critical appraisal, and evidence-based recommendations. Anesth Analg, 2012; 114(5): 1,003–14.

7. Chao CM, Lai CC, Chan KS, et al. Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units: A 15-year experience. Medicine (Baltimore), 2017; 96(27): e6877.

8. Bouza C, et al. Unplanned extubation in orally intubated medical patients in the intensive care unit: a prospective cohort study. Heart Lung, 2007; 36(4): 270–6.

9. Aydogan S, Kaya N. The Assessment of the Risk of Unplanned Extubation in an Adult Intensive Care Unit. Dimens Crit Care Nurs, 2017; 36(1): 14–21.

10. de Lassence A, et al., Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: a prospective multicenter study. Anesthesiology, 2002; 97(1): 148–56.

11. Phoa LL, et al. Unplanned extubation: a local experience. Singapore Med J, 2002; 43(10): 504–8.

12. Kiekkas P, et al. Unplanned extubation in critically ill adults: clinical review. Nurs Crit Care, 2013; 18(3): 123–34.

13. Wang HE, et al. Preliminary experience with a prospective, multi-centered evaluation of out-of-hospital endotracheal intubation. Resuscitation, 2003; 58(1): 49–58.

14. Kupas DF, Kauffman KF, Wang HE. Effect of airway-securing method on prehospital endotracheal tube dislodgment. Prehosp Emerg Care, 2010; 14(1): 26–30.

15. Meyers JM, Pinheiro J, Nelson MU. Unplanned extubation in NICU patients: Are we speaking the same language? J Perinatol, 2015; 35(9): 676–7.

16. Barber JA. Unplanned extubation in the NICU. J Obstet Gynecol Neonatal Nurs, 2013; 42(2): 233–8.

17. Silva PS, Reis ME, Aguiar VE, Fonseca MC. Unplanned extubation in the neonatal ICU: a systematic review, critical appraisal, and evidence-based recommendations. Respir Care, 2013; 58(7): 1,237–45.

18. Franck LS, Vaughan B, Wallace J. Extubation and reintubation in the NICU: identifying opportunities to improve care. Pediatr Nurs, 1992; 18(3): 267–70.

19. Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med, 2005 Jun; 33(6): 1,266–71.

20. Needham DM, Pronovost PJ. The importance of understanding the costs of critical care and mechanical ventilation. Crit Care Med, 2005; 33(6): 1,434–5.

21. Veldman A, et al. Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit. Paediatr Anaesth, 2006; 16(9): 968–73.

22. Roddy DJ, et al. Unplanned Extubations in Children: Impact on Hospital Cost and Length of Stay. Pediatr Crit Care Med, 2015; 16(6): 572–5.

23. Kwon E, Choi K. Case-Control Study on Risk Factors of Unplanned Extubation Based on Patient Safety Model in Critically Ill Patients with Mechanical Ventilation. Asian Nurs Res (Korean Soc Nurs Sci), 2017; 11(1): 74–78.

24. Chen CZ, et al. Factors predicting reintubation after unplanned extubation. J Formos Med Assoc, 2002; 101(8): 542–6.

25. Kanthimathinathan HK, et al. Unplanned extubation in a paediatric intensive care unit: prospective cohort study. Intensive Care Med, 2015; 41(7): 1,299–306.

26. Klugman D, et al. Acute harm: unplanned extubations and cardiopulmonary resuscitation in children and neonates. Intensive Care Med, 2013; 39(7): 1,333–4.

27. Fisher DF, et al. Comparison of commercial and noncommercial endotracheal tube-securing devices. Respir Care, 2014; 59(9): 1,315–23.

28. Gardner A, et al. Best practice in stabilisation of oral endotracheal tubes: a systematic review. Aust Crit Care, 2005; 18(4): 158, 160–5.

29. Mohammed H, Hassan MS. Endotracheal tube securements: Effectiveness of three techniques among orally intubated patients. Egyptian Journal of Chest Diseases and Tuberculosis, 2014; 64: 183–96.

30. Fenje N, Steward DJ. A study of tape adhesive strength on endotracheal tubes. Can J Anaesth, 1988; 35(2): 198–201.

31. Lovett PB, et al. The insecure airway: a comparison of knots and commercial devices for securing endotracheal tubes. BMC Emerg Med, 2006; 6: 7.

32. Krug L, Machan M, Villalba J. Securing the endotracheal tube with adhesive tape: an integrative literature review. AANA J, 2014 Dec; 82(6): 457–64.

33. Buckley JC, et al. Comparison of the Haider Tube-Guard Endotracheal Tube Holder Versus Adhesive Tape to Determine if This Novel Device Can Reduce Endotracheal Tube Movement and Prevent Unplanned Extubation. Anesth Analg, 2016; 122(5): 1,439–43.

34. Carlson J, et al. Extubation force: tape versus endotracheal tube holders. Ann Emerg Med, 2007; 50(6): 686–91.

35. Yilmaz B, Colakoglu K, Gurunluoglu R. Skin avulsion injury during endotracheal tube extubation—case report of an unusual complication. Patient Saf Surg, 2008; 2: 12.

36. Wagner JL, Shandas R, Lanning CJ. Extubation force depends upon angle of force application and fixation technique: a study of 7 methods. BMC Anesthesiol, 2014; 14: 74.

37. Boulain T. Unplanned extubations in the adult intensive care unit: a prospective multicenter study. Association des Reanimateurs du Centre-Ouest. Am J Respir Crit Care Med, 1998; 157(4 Pt 1): 1,131–7.

38. McNett M, Kerber K. Unplanned extubations in the ICU: Risk factors and strategies for reducing adverse events. J Clin Outcomes Management, 2015; 22(7).

39. Chang LY, Wang KW, Chao YF. Influence of physical restraint on unplanned extubation of adult intensive care patients: a case-control study. Am J Crit Care, 2008; 17(5): 408–15; quiz 416.

40. Oliveira PC, et al. Incidence and primary causes of unplanned extubation in a neonatal intensive care unit. Rev Bras Ter Intensiva, 2012; 24(3): 230–5.

41. Mehta NM, Sharma S, Laussen PC. Unplanned extubation: securing the tool of our trade. Intens Care Med, 2015; 41(11): 1,983–5.

42. Murdoch E, Holdgate A. A comparison of tape-tying versus a tube-holding device for securing endotracheal tubes in adults. Anaesth Intensive Care, 2007; 35(5): 730–5.

43. Carlson JN, Mayrose J, Wang HE. How much force is required to dislodge an alternate airway? Prehosp Emerg Care, 2010; 14(1): 31–5.

44. Barnason S, et al. Comparison of two endotracheal tube securement techniques on unplanned extubation, oral mucosa, and facial skin integrity. Heart Lung, 1998; 27(6): 409–17.

45. Patient Safety Movement. Actionable Patient Safety Solutions. Challenge 8B: Unplanned Extubation, https://patientsafetymovement.org/actionable-solutions/challenge-solutions/airway-safety/unplanned-extubation/. 

46. Hampson J, et al. Impact of the introduction of an endotracheal tube attachment device on the incidence and severity of oral pressure injuries in the intensive care unit: a retrospective observational study. BMC Nurs, 2018; 17: 4.

47. Artime CA, Hagberg CA. Tracheal extubation. Respir Care, 2014 Jun; 59(6): 991–1,002; discussion 1,002–5.

  • Format
    Article
  • Duration
    1 Hour
  • Credits
    1 CE
  • Cost
    $
    7.50