SY Lam, H Ng, R Wong, KT So

Objective: To identify the frequency, outcome and factors associated with unplanned extubation in an intensive care unit.

Method: Prospective study in a 15-bed combined paediatric and neonatal intensive care unit in a regional hospital, Tuen Mun hospital.

Results: Twenty-three episodes of unplanned extubations (age: 3 days to 11 month) occurred during a period of 10 months. In 10 episodes (44%), reintubation was performed within first 24 hours. Mild complications including transient bradycardia and desaturations were detected in 5 episodes (20%). One extubation resulted in cardiac arrest and the patient was revived after cardiac massage. 11 incidences (49%) occurred during the period between 9:15 pm and 7 am, when the nurse - patient ratio dropped from 1:1 to 1:3. In only three episodes were related to loose strappings. In 11 episodes (48%) the extubations were related to irritability of the patients. Though 14 of 23 episodes were prescribed sedatives for mechanical ventilation, only 3 cases were under sedation during unplanned extubation. Restraints were only used in 3 cases.

Conclusions: Unplanned extubations can result in serious complications. All patients should be observed closely after extubations though majority of patients did well and did not need re-intubations. Factors that may improve the incidence of unplanned extubations include adequate sedation and hand restraints. However, further studies are needed to prove the efficacy of the suggested interventions.