Unplanned extubation among critically ill adults: A systematic review and meta-analysis

Li, Pengbo; Sun, Zihong; Xu, Jingyi

doi:10.1016/j.iccn.2022.103219

Cited by 10 publications

(9 citation statements)

References 33 publications

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“…This result is consistent with the results of a recent meta-analysis that found a combined incidence of 1.06 UEs per 100 MV days across 16 studies. 13 Moreover, Da Silva et al 2 found a similar incidence in their 2012 meta-analysis demonstrating stable UE rate over time. The incidence of UE differed widely between centres (ranging from of 0 to 4.3 UEs per 100 MV days in our study), explaining the differing results found in previous mostly single-centre studies.…”

Section: Discussionmentioning

confidence: 84%

Prospective multi-centre evaluation of the incidence of unplanned extubation and its outcomes in intensive care units. The Safe-ICU study

Guillemin

Rieu

Huet

et al. 2023

Preprint

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Background: The lack of a clear definition and strong methodology has led to differing results in terms of unplanned extubation (UE) epidemiology and outcomes. We aimed to determine the UE incidence and clinical significance of both accidental extubation and self-extubation. Methods: A multicentric prospective cohort study was conducted in 47 French ICUs. The number of mechanical ventilation (MV) days, planned and unplanned extubation were recorded in each centre over a minimum period of three consecutive months to evaluate UE incidence. Patient characteristics, UE environmental factors, and outcomes (follow-up until ICU discharge or day 28) were compared based on the UE mechanism (accidental or self-extubation). Finally, we determined ‘failed’ self-extubation (re-intubation at day 7) prognosis and risk factors. Results: During the 12-month inclusion period, we found a pooled UE incidence of 1.0 per 100 MV days. UE accounted for 9% of all endotracheal removals. Of the 635 UE, 88% were self-extubations and 12% were accidental extubations. The latter had a worse prognosis than self-extubations (34% vs 14% mortality, p <0.001). Self-extubation failure, which occurred in 35% of self-extubation patients, was associated with excess mortality (15% vs 4%, p <0.001). Cancer, higher respiratory rate, lower PaO2/FiO2, weaning process not ongoing, and immediate post-extubation respiratory failure were independent predictors of failed self-extubation. Discomfort was the leading cause of self-extubation reported by both patients and physicians, ahead of agitation. Conclusion: Unplanned extubation is common in ICU and accounts for 9% of all endotracheal removals. Accidental extubation has a poorer prognosis than self-extubation.

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Section: Discussionmentioning

confidence: 84%

Prospective multi-centre evaluation of the incidence of unplanned extubation and its outcomes in intensive care units. The Safe-ICU study

Guillemin

Rieu

Huet

et al. 2023

Preprint

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“…중환자실 간호사는 높은 중증도, 고위험 약물 및 의료기기, 빈번한 응급상황, 과도한 업무량과 다학제 간 협력이 필요한 복잡한 근무 환경 속에서 간호를 제공한다 [4]. 중환자실 간호 사는 투약 오류, 의료장비 문제, 환자 확인 누락, 침습적 카테터 와 배액관 감염, 카테터의 비계획적 탈관 [5] 등의 환자안전사 건을 적게는 2.0%에서 많게는 70.0%까지 경험한다 [6,7]. 이러 한 중환자실 내 환자안전사건은 환자의 재원 일수를 증가시키 고, 추가적인 처치를 발생시키며 [7], 심각한 경우 환자를 사망 에 이르게 한다 [6].…”

Section: 서 론unclassified

Development of a Patient Safety Simulation Program for New Nurses in the Intensive Care Unit

Jung,

Park

2024

J Korean Acad Fundam Nurs

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Purpose: Intensive care units (ICUs) are departments that use high-risk drugs and medical devices. Therefore, patient safety is especially important in ICUs. However, new nurses in ICUs often lack patient safety competencies. Thus, it is necessary to improve patient safety competencies for new nurses working in ICUs.Methods: This methodological study was designed to develop a simulation program to improve patient-safety competencies among new nurses working in ICUs. To develop a patient-safety simulation program, we conducted a survey on educational needs and reviewed the core competencies of patient safety applicable to healthcare providers. Additionally, we conducted an expert validation process and a pilot test.Results: A simulation-based patient safety program was developed that spanned 4 weeks (240 minutes).Conclusion: The patient safety simulation program, which considered the characteristics and competence levels of new nurses working in ICUs, was found to be appropriate. This program is expected to improve the patient safety competencies of new intensive care nurses, thereby contributing to the creation of a safer ICU environment.

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“…3,4 The incidence of UEE is an important and sensitive indicator of the quality of nursing care for ICU patients, and it has been reported to be between 1.02% and 32.1%. [5][6][7][8][9] Notably, UEE can cause various serious complications, such as asphyxia, malignant arrhythmia, and aspiration pneumonia, 10 prolong the duration of mechanical ventilation and ICU stay of patients, and increase the morbidity and mortality rate. 11 Therefore, its prevention in ICU patients with TEI is important for critical care.…”

Section: Introductionmentioning

confidence: 99%

“…Transoral endotracheal intubation (TEI) is a very important means to resuscitate critically ill patients; however, unplanned endotracheal extubation (UEE) is among the most common adverse events after TEI, including accidental extubation by healthcare workers during therapeutic operations at the bedside 1,2 and self‐extubation by patients 3,4 . The incidence of UEE is an important and sensitive indicator of the quality of nursing care for ICU patients, and it has been reported to be between 1.02% and 32.1% 5–9 . Notably, UEE can cause various serious complications, such as asphyxia, malignant arrhythmia, and aspiration pneumonia, 10 prolong the duration of mechanical ventilation and ICU stay of patients, and increase the morbidity and mortality rate 11 .…”

Section: Introductionmentioning

confidence: 99%

Development and testing of a questionnaire assessing knowledge, attitudes, and practices to prevent unplanned oral extubation

Wang,

Pan,

Sun

et al. 2023

Nursing in Critical Care

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BackgroundThe prevention of unplanned endotracheal extubation (UEE) is significant for the critical care of intensive care unit (ICU) patients.AimTo develop a questionnaire to assess the knowledge, attitude, and practice (KAP) of the nurses regarding of the prevention of UEE in ICU patients with transoral endotracheal intubation (TEI) and to test the validity and reliability of the questionnaire.Study DesignItems relevant to KAP were prepared following a literature review, and then screened using a Delphi expert consultation, pre‐test, and factor analysis. The nursing staffs in four tertiary hospitals in Qinghai, Jiangsu, Gansu, and Shandong provinces were surveyed to test the reliability and validity of the questionnaire.ResultsThe questionnaire contained 76 items, including 10, 37, and 29 in the dimensions of knowledge, attitude, and practice, respectively. The scale‐level content validity index (S‐CVI) of the questionnaire was 0.96. The results of exploratory factor analysis (EFA) showed that the Kaiser–Meyer–Olkin value was 0.956, indicating that the sample was adequate and suitable for factor analysis. The result of the Bartlett spherical test was significant (p < .001), indicating that the questionnaire was suitable for further EFA. A total of six common factors were extracted by EFA with a cumulative variance interpretation rate of 85.52%, indicating that the questionnaire had good structural validity. The Cronbach's alpha was 0.981 for the whole questionnaire; and was 0.966, 0.996, and 0.981 for the dimensions of knowledge, attitude, and practice, respectively. The test–retest reliability for the questionnaire was 0.843.ConclusionsThe developed questionnaire has good reliability and validity and can be used as a scientific tool for the nursing leaders to prevent UEE in ICU patients with TEI.Relevance to Clinical PracticeThe instrument provides a theoretical reference for establishing preventive strategies and management programs in clinical practice.

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Unplanned extubation among critically ill adults: A systematic review and meta-analysis

Cited by 10 publications

References 33 publications

Prospective multi-centre evaluation of the incidence of unplanned extubation and its outcomes in intensive care units. The Safe-ICU study

Prospective multi-centre evaluation of the incidence of unplanned extubation and its outcomes in intensive care units. The Safe-ICU study

Development of a Patient Safety Simulation Program for New Nurses in the Intensive Care Unit

Development and testing of a questionnaire assessing knowledge, attitudes, and practices to prevent unplanned oral extubation

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