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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.


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


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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.

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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.

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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.

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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.

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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.

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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.

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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, 

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
  • Duration
    1 Hour
  • Credits
    1 CE
  • After passing the course, your certificate will be available for download here.