- Poster presentation
- Open Access
Prevention of unplanned extubations in the ICU: results of a nurse-driven endotracheal tube care protocol
Critical Care volume 12, Article number: P435 (2008)
Unplanned extubations (UEs) can be accidental or intentional (autoextubation). The incidence of UE is 1–4/100 ventilator-days and is considered a quality indicator for nursing care in the ICU. We studied the effect of a predominantly nurse-driven endotracheal tube care (ETTC) protocol on incidence, circumstances, and outcome of UEs in orotracheally intubated mechanically ventilated patients.
A 1-year prospective observational study in a 24-bed mixed medicosurgical ICU in a university hospital. The ETTC protocol includes: endotracheal tube (ETT) fixation with waterproof adhesive plaster and/or adapted tubeholder; wrist fixation in all patients; nurse-driven sedation and analgesia supervised by a dedicated ICU physician; pressure support weaning using a flow trigger and tube compensation when possible, actively steered by a nurse and a respiratory physiotherapist; special care to avoid ETT dislocation during mobilisation or transport of the patient; and prompt pharmacological treatment of the restless or agitated patient.
Six hundred and eighty-eight patients were ventilated during 4,605 days. The incidence of UE was 0.32/100 ventilation-days. Autoextubation occurred in 11 (73%) patients, mostly (82%) during the evening or night shift, and in the absence of a nurse in the patient's room. All patients had been successfully weaned and were free of sedation. No patient had to be reintubated. All accidental extubations (n = 4; 27%) occurred in the immediate postoperative phase following cardiac bypass surgery and in the presence of a nurse and/or physiotherapist at the bedside. Seventy-five percent took place during morning shifts in full-sedated patients and were due to ETT dysfunction. All patients were promptly reintubated. UEs never occurred during patient mobilisation or transport. No patient died as a result of UE.
The implementation of a nurse-driven ETTC protocol for prevention of UE resulted in a very low incidence of UE, in a low number of accidental UEs occurring in relatively controlled circumstances, in no UEs during patient mobilisation, and in no excess morbidity and mortality.
About this article
Cite this article
Delvaux, R., Tavernier, K., Sevenois, M. et al. Prevention of unplanned extubations in the ICU: results of a nurse-driven endotracheal tube care protocol. Crit Care 12, P435 (2008). https://doi.org/10.1186/cc6656
- Pressure Support
- Night Shift
- Care Protocol
- Adhesive Plaster
- Patient Mobilisation