Characteristics Associated With Unplanned Extubations in a Surgical Intensive Care Unit

Background Unplanned extubations can result in serious complications. Objectives To determine characteristics of patients and nurses and risk factors that affect extubations. Methods A retrospective exploratory design was used. Ramsay Sedation Scale scores, need for reintubation, time between intubation and extubation, use of sedation and analgesia in the preceding 48 hours, and use of restraints were collected on 31 patients in a surgical intensive care unit who had unplanned extubations. For nurses, data collected included years' experience in nursing and as an intensive care nurse, professional credentials, and location at the time of extubation. Results All unplanned extubations were self-extubations; 15 required reintubation. Most patients had low levels of sedation in the hour preceding the extubation ( mean Ramsay score, 2.42; SD, 1.06). Patients who needed reintubation had higher mean Ramsay scores (2.85; SD, 1.14) than patients who did not (2.00; SD, 0.86; P =. 04). Ramsay scores correlated with need for reintubation (r = 0.423; P =. 03). Of the 31 patients, 27 (87%) were restrained at the time of extubation(chi(2) = 17.06; df= 1; P <. 001). Among the nurses, 32.3% had less than 5 years' experience in nursing, and 51.6% had less than 5 years' experience in intensive care; 89% of extubations occurred when the nurse was away from the bedside. Sedative and analgesic doses in the 24 hours before extubation did not differ significantly from those in the 2 hours before extubation. Conclusions Levels of sedation and use of restraints are associated with unplanned extubations and need for reintubation. (American Journal of Critical Care. 2008; 17: 45-52)