Dejan Doberšek

Univerzitetna klinika za pljučne bolezni in alergijo Golnik (Slovenija)

ICU, mechanical ventilation, extubation, risk factors and complications of unplanned endotracheal extubation

''7. Međunarodni kongres HDMSARIST-a''

Šibenik, 24.-27. travnja 2014. godine

One of the frequent complications that occurs in the Intensive Care Unit and is
associated with mechanically ventilated patients is unplanned extubation. Unplanned
extubation is otherwise also known as premature extubation, or self extubation.
Unplanned extubation may either be caused by the patient or the medical personnel.
The reasons for an unplanned extubation are numerous: physical restraint of the
patient, improper use of sedatives and/or the level of sedation, poor fixation of the
endotracheal tube and an inadequate ratio between the number of nurses and
patients. Unplanned extubations may pose a serious risk to the patient's health
condition in the Intensive Care Unit. The complications that can occur in unplanned
extubations include bronchospasm, respiratory tract damage, aspiration,
arrhythmias, hypotension, respiratory arrest and death. The results of the
complications are extended hospitalization time and increased costs of treatment.
Numerous studies of unplanned extubation were published and only few of them
assessed risk factors to reduce the incidence of unplanned extubation. The authors
pointed out the following: continuous education for nurses, agitation avoidance, 24-hour bedside supervision, regular surveillance, proper fixation of the tube and control
of them between nursing care, protocols for sedation of patients, ability of staff to
identify patients for weaning from mechanical ventilation and appropriate nurse to
patient ratio.

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