The relationship of sedation to deliberate self-extubation

Tung, Avery; Tadimeti, Lakshminarayana; Caruana-Montaldo, Brendan; Atkins, Peter; Mion, Lorraine C.; Palmer, Robert M.; Slomka, Jacquelyn; Mendelson, Wallace B.

doi:10.1016/s0952-8180(00)00237-3

Cited by 55 publications

(49 citation statements)

References 14 publications

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“…19 This association may also reflect the deliriogenic effect of benzodiazepines as sedative agents. [20][21][22][23] In addition, some patients who inappropriately receive benzodiazepines for the management of pain may be predisposed to delirium with paradoxical excitation.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22][23] In addition, some patients who inappropriately receive benzodiazepines for the management of pain may be predisposed to delirium with paradoxical excitation. Tung et al 19 compared patients who self-extubated with a matched group of control patients and found that the patients with unplanned extubation were twice as likely to be agitated (54% vs 22%; P < .05). Strøm et al 24 compared no sedation with continuous sedation with propofol and midazolam with DIS.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Sedation Strategies on Unplanned Extubation in a Mixed Intensive Care Unit

Tanios¹,

Epstein²,

Grzeskowiak³

et al. 2014

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Define unplanned extubation. 2. Explain possible causes of unplanned extubation. 3. Identify the relationship between sedation strategy and unplanned extubation. Results A total of 92 unplanned extubations occurred (7.5 events/1000 days of mechanical ventilation): patients who were receiving continuous sedation protocol with daily interruption of sedatives had 1.5 events/1000 ventilator days, patients receiving the intermittent sedation protocol had 5.0 events/1000 days, and patients with no sedation protocol had 16 events/1000 days (P < .05). Median duration of mechanical ventilation before unplanned extubation was 2 days. Most unplanned extubations (94%) were deliberate, and 53% occurred in patients scheduled for weaning. Most unplanned extubations in the continuous sedation protocol group (71%) occurred during weaning, in comparison to the intermittent sedation protocol (54%) and no sedation protocol groups (48%, P < .05). The highest incidences of agitation were in patients receiving the intermittent sedation protocol as compared with the other 2 groups (77% vs 50% vs 49%, P < .05). Overall, 73% of patients who had an unplanned extubation did not require reintubation; those who did were older (mean age: 68 vs 53 years, P = .01) and were male (80% vs 20%, P = .02). Reintubation was unrelated to the time of unplanned extubation. Conclusion Strategies of no sedation or intermittent sedation are both associated with higher rates of unplanned extubation when compared to a strategy of continuous sedation with daily interruption of sedatives. Sedation strategies that allow agitation may increase the risk of unplanned extubation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of Sedation Strategies on Unplanned Extubation in a Mixed Intensive Care Unit

Tanios¹,

Epstein²,

Grzeskowiak³

et al. 2014

American Journal of Critical Care

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“…Although approaches for managing ‘ dangerous motor activity ’ in the form of pharmacological interventions were outlined, there remains a lack of guidance for managing the acute event of a mobile, agitated patient who is a risk to themselves, visitors and staff. Although short-term sedative use may reduce the agitation or anxiety, in the longer term, their use may have significant cognitive consequences 13. Participants described observing a range of forms of restraint, both physical and chemical, and perceived that clinical staff considered chemical restraint, such a boluses of sedative drugs as ‘kinder’, allowing the patient to ‘sleep’ (figure 2).…”

Section: Key Messages From the Twitter Chat (#Ebnjc)mentioning

confidence: 99%

Critical care nursing: caring for patients who are agitated

Freeman¹,

Teece

2017

Evid Based Nurs

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“…In a retrospective study conducted by Tung, the average age of patients who self-extubated was 65.3 years. 7 Patients between ages 30-50 account for 47% of self-extubation episodes; 58.9% of episodes occur in surgical patients. 1 Self-extubation also occurs more frequently in patients with certain conditions, such as chronic obstructive pulmonary disease, adult respiratory distress syndrome, or cardiac disease.…”

Section: Circumstances a Patient Relatedmentioning

confidence: 99%

“…He reported that 65% of patients who self-extubated were restrained either at the time of self-extubation or within 24 hours of self-extubation. 7 Restraints are often used with agitated or delirious patients, whose risk for self-extubation is already increased. A quality improvement initiative increased restraint use in agitated patients from 58% to 90% over four years and saw a 6% decrease in the number of self-extubations.…”

Section: Preventionmentioning

confidence: 99%