Can We Identify Patients at High Risk for Unplanned Extubation? A Large-Scale Multidisciplinary Survey

BACKGROUND: Unplanned extubation represents a threat to patient safety, and risk factors and prevention strategies for unplanned extubation have not been fully explored.

OBJECTIVES: To define high-risk patients for unplanned extubation and determine clinicians' beliefs on perceived risks for unplanned extubation

METHODS: With a Web-based survey instrument we surveyed critical care clinician members of the American Association for Respiratory Care, the American Association of Critical Care Nurses, and the Society of Critical Care Medicine.

RESULTS: Surveys were completed by 1,976 clinicians, including 419 respiratory therapists, 870 critical care nurses, and 605 critical care physicians. The majority of respondents considered an outward migration of the endotracheal tube (by 3 cm, 2 cm if an air leak is present) to represent a risk for unplanned extubation. Respondents considered the following as high risk for unplanned extubation: absence of physical restraints (72% of respondents), a nurse/patient ratio of 1/3 (60%), trips out of the intensive care unit (59%), light sedation (43%), and bedside portable radiograph (29%). In addition, most respondents considered accidental removal of the nasogastric tube (71%) or tugging on the endotracheal tube (87%) by the patient to be risk factors for unplanned extubation. The rank order of the perceived risks was related to the respondents' primary discipline.

CONCLUSIONS: We identified perceived risk factors and defined “near misses” for unplanned extubation. Our findings should inform strategies for prevention of unplanned extubation.