Friday October 27, 2006
Unplanned extubations (UE)

Unplanned extubations in ICUs have been reported anywhere from 1-16% with higher incidence in surgical ICUs.

Unplanned extubations have been tagged as one of the "outcome measures" in famous article published earlier this year - "Intensive care unit quality improvement: A how-to guide for the interdisciplinary team" 1.


To improve the UE rate, one study was done at at St. Joseph’s Hospital in Marshfield, Wis., where a committee comprised of an intensivist, the respiratory therapy staff and the nursing staff looked into frequency of unplanned extubations in the adult ICUs during a 6-month period (see the incident report form in reference). After obtaining data, committee took 2 steps approach.

As a first step, the committee examined various endo-tracheal tube (ETT) holders available, looking at design, securability, ease of application, durability, ease to maintain the integrity of the oral mucosa and to maintain skin integrity beneath the area of application. After selecting the product, second step was taken and extensive in-service training sessions were done over 2 weeks spreading over all shifts for the nursing and the respiratory staff including right technique, taping, application of an adhesive skin preparation etc.

Rate of UE was compared 6 months preceding staff education with the 6 months after staff education. In the CCU/ MICU, the unplanned extubation rate decreased from 2.14% to 0.87% and in the SICU, the unplanned extubation rate decreased from 2.32% to 1.0% (10 extubations in 1000 days) after the education 2.


References: click to get abstract/article

1. Intensive care unit quality improvement: A "how-to" guide for the interdisciplinary team - Critical Care Medicine. 34(1):211-218, January 2006
2. Unplanned Extubation in Adult Critical Care - Critical Care Nurse. 2004;24: 32-37
3. The Drive to Survive, Unplanned Extubation in the ICU - Chest. 2005;128:560-566