Factors associated with unplanned extubation in the Intensive Care Unit for adult patients: A systematic review and meta-analysis

Objectives: To explore factors associated with unplanned extubation in Intensive Care Unit for adult patients. Research methodology: A systematic review and meta-analysis were performed of studies identified through Pubmed, CINAHL, Cochrane Library, PsycINFO and Web of Science published from initiation to September 2017. Only articles in English were included. The Newcastle-Ottawa Scale was used to evaluate the quality of the included articles. Results: Ten eligible studies were identified, encompassing a total of 2092 patients (457 in the unplanned extubation group; 1635 in the control group). The subsequent meta-analysis identified significant risk factors for unplanned extubation are male [odds ratio (OR) 1.54, 95% CI 1.12-2.12; P = 0.008], confusion [OR 0.10, 95% CI 0.05-0.17; P < 0.00001], physical restraint [OR 3.10, 95% CI 2.21-4.34; P < 0.00001], higher GCS scores [mean difference (MD) 1.06, 95% CI 0.59-1.52; P < 0.00001] and lower APACHE II scores [MD -2.26, 95% CI -3.35- -1.16; P < 0.0001]. Renal disease is a protective factor for unplanned extubation [OR 0.32, 95% CI 0.15-0.70; P = 0.004]. Conclusion: Patients were male, confused, having physical restraint, with higher GCS and lower APACHE II scores are significant risk factors for unplanned extubation in Intensive Care Unit adult patients. (C) 2018 Elsevier Ltd. All rights reserved.