BACKGROUND: Unplanned extubation commonly occurs in intensive care units. Various physical restraints have been used to prevent patients from removing their endotracheal tubes. However, physical restraint not only does not consistently prevent injury but also may be a safety hazard to patients. OBJECTIVES: To evaluate the effect of physical restraint on unplanned extubation in adult intensive care patients. METHODS: A total of 100 patients with unplanned extubations and 200 age-, sex-, and diagnosis-matched controls with no record of unplanned extubation were included in this case-control study. The 300 participants were selected from a population of 1455 patients receiving mechanical ventilation during a 21-month period in an adult intensive care unit at a medical center in Taiwan. Data were collected by reviewing medical records and incident reports of unplanned extubation. RESULTS: The incidence rate of unplanned extubation was 8.7%. Factors associated with increased risk for unplanned extubation included use of physical restraints (increased risk, 3.11 times), nosocomial infection (increased risk, 2.02 times), and a score of 9 or greater on the Glasgow Coma Scale on admission to the unit (increased risk, 1.98 times). Episodes of unplanned extubation also were associated with longer stays in the unit. CONCLUSIONS: An impaired level of consciousness on admission to the intensive care unit and the presence of nosocomial infection intensify the risk for unplanned extubation, even when physical restraints are used. To minimize the risk of unplanned extubation, nurses must establish better standards for using restraints.
BACKGROUND: Unplanned extubation commonly occurs in intensive care units. Various physical restraints have been used to prevent patients from removing their endotracheal tubes. However, physical restraint not only does not consistently prevent injury but also may be a safety hazard to patients. OBJECTIVES: To evaluate the effect of physical restraint on unplanned extubation in adult intensive care patients. METHODS: A total of 100 patients with unplanned extubations and 200 age-, sex-, and diagnosis-matched controls with no record of unplanned extubation were included in this case-control study. The 300 participants were selected from a population of 1455 patients receiving mechanical ventilation during a 21-month period in an adult intensive care unit at a medical center in Taiwan. Data were collected by reviewing medical records and incident reports of unplanned extubation. RESULTS: The incidence rate of unplanned extubation was 8.7%. Factors associated with increased risk for unplanned extubation included use of physical restraints (increased risk, 3.11 times), nosocomial infection (increased risk, 2.02 times), and a score of 9 or greater on the Glasgow Coma Scale on admission to the unit (increased risk, 1.98 times). Episodes of unplanned extubation also were associated with longer stays in the unit. CONCLUSIONS: An impaired level of consciousness on admission to the intensive care unit and the presence of nosocomial infection intensify the risk for unplanned extubation, even when physical restraints are used. To minimize the risk of unplanned extubation, nurses must establish better standards for using restraints.
Authors: Bernard De Jonghe; Jean-Michel Constantin; Gerald Chanques; Xavier Capdevila; Jean-Yves Lefrant; Hervé Outin; Jean Mantz Journal: Intensive Care Med Date: 2012-10-13 Impact factor: 17.440
Authors: Tae Won Lee; Jeong Woo Hong; Jung-Wan Yoo; Sunmi Ju; Seung Hun Lee; Seung Jun Lee; Yu Ji Cho; Yi Yeong Jeong; Jong Deog Lee; Ho Cheol Kim Journal: Tuberc Respir Dis (Seoul) Date: 2015-10-01
Authors: Elena Luk; Barbara Sneyers; Louise Rose; Marc M Perreault; David R Williamson; Sangeeta Mehta; Deborah J Cook; Stephanie C Lapinsky; Lisa Burry Journal: Crit Care Date: 2014-03-24 Impact factor: 9.097
Authors: Farhad N Kapadia; Pandurang C Tekawade; Shruti S Nath; Sharad S Pachpute; Sanjay S Saverkar; Rupali A Bhise; Aarti C Chavan; Sholly J Varghese; Vidya U Kantak; Rohini V Kshirsagar; Vaishali A Neve; Samona O D'souza Journal: Indian J Crit Care Med Date: 2014-05