Unplanned extubation.
Subject: Medical research
Medicine, Experimental
Authors: Cramer, Matthew
Jenkins, Peggy
Pub Date: 09/22/2010
Publication: Name: Journal of the New York State Nurses Association Publisher: New York State Nurses Association Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 New York State Nurses Association ISSN: 0028-7644
Issue: Date: Fall-Winter, 2010 Source Volume: 41 Source Issue: 2
Product: Product Code: 8000200 Medical Research; 9105220 Health Research Programs; 8000240 Epilepsy & Muscle Disease R&D NAICS Code: 54171 Research and Development in the Physical, Engineering, and Life Sciences; 92312 Administration of Public Health Programs
Accession Number: 257675203
Full Text: Chang, L., Wang, K., & Chao, Y (2008). Influence of physical restraint on unplanned extubation of adult intensive care patients: A case control study. American Journal of Critical Care, 17(5), 408-415.

Unplanned extubation is a worldwide and life-threatening problem that is associated with physical restraints. In a study by Curry and colleagues (2008), At the time of extubation, 87% of patients were restrained. The problem of unplanned extubation has been studied in much of the developed world and is now being explored in developing countries. Unplanned extubation can lead to problems including hemodynamic complications and can also lengthen patient stay in the intensive care unit (ICU). The purpose of this study was to identify factors that lead to unplanned extubation and to determine risk factors for unplanned extubation in restrained patients in Taiwan.

The study population included all adult ICU patients in a veteran's hospital in Taiwan between October 2003 and July 2005. From the population of 1,455 intubated patients, a sample of 126 self-extubated patients was selected for study out of 300 unplanned extubations.

In this retrospective study, data reviewed from charts contained consciousness status, days of mechanical ventilation, ventilation parameters, presence of nosocomial infection, use of sedatives, and use of physical restraint. The Mann-Whitney test, chi-squared, t-test, risk estimation, and receiver-operating characteristic curve analysis were employed. Glasgow Coma Scale (GCS) scores of 9 or above when combined with physical restraint and nosocomial infection produced significant rates of self-extubation. A GCS of less than 9 with the same factors, however, led to lower rates of self-extubation.

Unplanned extubation caused by physical restraint has been shown to be an issue in both developed and undeveloped countries. The study author recommends protocols for the use of physical restraints in intubated patients based on GCS scores and nosocomial infection diagnoses; yet now may be the time to consider alternatives to physical restraints in intubated patients. Solving this problem is part of a nurse's ethical duty to support beneficence and patient autonomy in delivery of care.

Reference

Curry, K., Cobb, S., Kutash, M., & Diggs, C. (2008). Characteristics associated with unplanned extubations in a surgical intensive care unit. American Journal of Critical Care, 17(1), 45-52.

Matthew Cramer, Bassett Healthcare, Cooperstown, NY

Peggy Jenkins, Hartwick College, Oneonta, NY
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