Self-extubation in ICU patients

Selvan, Kavitha; Edriss, Hawa; Sigler, Mark; Tseng, Jim

doi:10.12746/swrccc.v2i8.169

Cited by 5 publications

(9 citation statements)

References 12 publications

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“…Over-sedation has been shown to lengthen ICU duration and put a patient at higher risk for delirium ( 81 ). In comparison, under-sedation has been linked with increased agitation and a higher risk of self-extubation ( 82 , 83 ). Optimizing sedation to better control patients' agitation may lower the patient's risk of removing endotracheal tubes ( 84 ).…”

Section: Behavioral Monitoringmentioning

confidence: 99%

Potentials and Challenges of Pervasive Sensing in the Intensive Care Unit

Davoudi

Shickel

Tighe

et al. 2022

Front. Digit. Health

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Patients in critical care settings often require continuous and multifaceted monitoring. However, current clinical monitoring practices fail to capture important functional and behavioral indices such as mobility or agitation. Recent advances in non-invasive sensing technology, high throughput computing, and deep learning techniques are expected to transform the existing patient monitoring paradigm by enabling and streamlining granular and continuous monitoring of these crucial critical care measures. In this review, we highlight current approaches to pervasive sensing in critical care and identify limitations, future challenges, and opportunities in this emerging field.

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Section: Behavioral Monitoringmentioning

confidence: 99%

Potentials and Challenges of Pervasive Sensing in the Intensive Care Unit

Davoudi

Shickel

Tighe

et al. 2022

Front. Digit. Health

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“…[2] Notably, the incidence rate of unplanned extubation ranges from 0.5% to 14.2%. [3] Among all cases of unplanned extubation, patient-induced self-extubation accounts for most cases (60%–90%). On the other hand, the accidental extubation mainly occurs due to coughing and change of position by the patient or during nursing procedures at the bedside.…”

Section: Introductionmentioning

confidence: 99%

“…[10] In addition, self-extubation is related to specific conditions such as pulmonary and cardiac diseases, and also, it may occur in patients admitted to the ICU after surgery or who had burn-related injuries. [3] Furthermore, nursing care significantly affects the incidence of self-extubation as the rate of unplanned extubation occurred more frequently when inexperienced nurses were on duty. [11] Self-extubation may cause damage to the larynx, hypotension, bronchospasm aspiration, bleeding, and edema.…”

Section: Introductionmentioning

confidence: 99%

“…[10] Moreover, around 20% of patients experience difficulty in reintubation following self-extubation. [3] However, the factors contributing to self-extubation and its associated complications are not well recognized and need to be explored further in our trauma center. Herein, we aim to evaluate the clinical characteristics, predisposing factors, complications, and outcomes among patients with traumatic head injury who underwent self-extubation in the ICU.…”

Section: Introductionmentioning

confidence: 99%

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Self-extubation in patients with traumatic head injury: Determinants, complications, and outcomes

Mahmood

El‐Menyar

et al. 2019

Anesth Essays Res

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Background:Self-extubation is a common clinical problem associated with mechanical ventilation in trauma patients worldwide.Objectives:This study aimed to evaluate the predisposing factors, complications, and outcomes of self-extubation in patients with head injury.Methods:This was a retrospective cohort study.Settings:The study was conducted in a trauma intensive care unit (TICU).Patients:All intubated patients with head injury admitted to TICU between 2013 and 2015 were included in the study.Interventions:Planned compared to selfextubation during weaning from sedation.Measurements:Risk, predictors, and outcomes of self-extubation were measured.Main Results:A total of 321 patients with head injury required mechanical ventilation, of which 39 (12%) had self-extubation and 12 (30.7%) had reintubation. The median Glasgow Coma Scale, head abbreviated injury score, and injury severity score were 9, 3, and 27, respectively. The incidence of self-extubation was 0.92/100 ventilated days. Self-extubated patients were more likely to be older, develop agitation (P = 0.001), and require restraints (P = 0.001) than those who had planned extubation. Furthermore, self-extubation was associated with more use of propofol (P = 0.002) and tramadol (P = 0.001). Patients with self-extubation had higher Ramsay sedation score (P = 0.01), had prolonged hospital length of stay (P = 0.03), and were more likely to develop sepsis (P = 0.003) when compared to the planned extubation group. The overall in-hospital mortality was significantly higher in the planned extubation group (P = 0.001). Age-adjusted predictors of self-extubation were sedation use (adjusted odds ratio [aOR]: 0.06; P = 0.001), restraint use (aOR: 10.4; P = 0.001), and tramadol use (aOR: 7.21; P = 0.01).Conclusions:More than one-tenth of patients with traumatic head injury develop self-extubation; this group of patients is more likely to have prescribed tramadol, develop agitation, and have longer hospital length of stay and less sedation use. Further prospective studies are needed to assess the predictors of self-extubation in TICU.

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“…1 Self-extraction behavior is defined historically as destructive actions directed toward persons, objects, or self is most commonly directed toward caregivers. 2 A literature search was conducted with the following search terms, keywords, and phrases: self-extraction behavior and neurological disturbances. The search was performed in the following databases: PubMed and Google Scholar.…”

Section: Introductionmentioning

confidence: 99%

Neurological Disturbances and Self-extraction Behavior: A Review

Renuka¹,

Nandhini²,

Angeline³

2013

Pondicherry Journal of Nursing

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Neurological disturbance describes the sudden onset of aggressive and violent behavior and autonomic dysfunction, typically in the setting of acute on chronic drug abuse or serious mental illness. It is mainly associated with delirium, dementia, and other behavioral disorders which are also collectively known as acute behavioral disturbances (ABD). Self-extraction behavior is common among patients admitted with neurological disturbances associated with certain medical and surgical disorders. The clinical characteristics of self-extraction behavior are pulling out of tubes, IV lines, interrupting medical treatment, and interfering with nursing procedures. Research literature was reviewed with regard to self-extraction behavior and its associated factors. A literature search was conducted with the following search terms, keywords, and phrases: self-extraction behavior and neurological disturbances. Totally 25 articles were reviewed by using the databases such as PubMed and Google Scholar, based on the criteria of clinical variables, demographic variables and self-extraction behavior. A considerable debate exists regarding the influencing factors for self-extraction behavior in patients with neurological disturbances. From this review, we infer that there are various contributing factors which influence the increased prevalence of self-extraction behavior among patients with neurological disturbances. The identified contributing factors are associated with clinical variables of patients. Research literature supports the necessity for understanding the associated risk factors for self-extraction behavior.

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Self-extubation in ICU patients

Cited by 5 publications

References 12 publications

Potentials and Challenges of Pervasive Sensing in the Intensive Care Unit

Potentials and Challenges of Pervasive Sensing in the Intensive Care Unit

Self-extubation in patients with traumatic head injury: Determinants, complications, and outcomes

Neurological Disturbances and Self-extraction Behavior: A Review

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