Nursing Department, Highest Technological Educational Institute of Patras, Patras 263-31, Greece.
Nurs Crit Care. 2013 May;18(3):123-34. doi: 10.1111/j.1478-5153.2012.00542.x. Epub 2012 Nov 22.
To investigate and synthesize the evidence on the incidence and consequences of unplanned extubation (UE) in intensive care unit (ICU) patients, and on risk factors for UE.
ICU patients generally spend considerable time being intubated via the endotracheal route. Non-planned endotracheal tube removal, either deliberate or accidental, may pose significant safety risks for them. As UE is among the most studied critical incidents in the ICU, evaluation and summary of existing findings could provide important implications for clinical practice. SEARCH STRATEGIES, INCLUSION AND EXCLUSION CRITERIA: Observational studies published between 1990 and 2012 in English-language journals indexed by Cumulative Index for Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science and the Cochrane Library were searched for studies on UE of critically ill adults. Thirty-three articles were considered eligible for inclusion.
UE incidence varies considerably among reports, with self-extubation representing the majority of cases. Agitation, especially when combined with inadequate sedation, and decreased patient surveillance are the major risk factors for UE. Inexperienced personnel and improper tube fixation may also be important, while physical restraint use remains controversial. UE can be followed by serious complications, mainly aspiration, laryngeal oedema and increased risk for pneumonia. Need for re-intubation is a major determinant of patient outcomes. Implementation of educational or quality improvement programs is expected to advance personnel's knowledge about risk factors for UE, promote skills on safe, standardized procedures for patient care and increase compliance with them.
Identifying risk factors for UE and minimizing UE incidence through appropriate preventive strategies are prerequisites for improving nursing care quality and patient safety in the ICU.
调查和综合 ICU 患者非计划性拔管（UE）的发生率和后果，以及 UE 的危险因素的证据。
ICU 患者通常需要通过气管内途径插管很长时间。非计划性的气管内导管移除，无论是故意还是意外，都可能对他们造成重大的安全风险。由于 UE 是 ICU 中研究最多的关键事件之一，对现有发现的评估和总结可为临床实践提供重要启示。
检索策略、纳入和排除标准：检索了 1990 年至 2012 年间在 CINAHL、PubMed、Web of Science 和 Cochrane 图书馆中索引的英文期刊上发表的关于危重成人 UE 的观察性研究。有 33 篇文章被认为符合纳入标准。
UE 的发生率在不同的报告中差异很大，其中自我拔管占大多数。躁动，特别是与镇静不足相结合，以及对患者的监测减少，是 UE 的主要危险因素。经验不足的人员和不当的管固定也可能很重要，而身体约束的使用仍然存在争议。UE 后可能会出现严重并发症，主要是吸入、喉水肿和肺炎风险增加。需要重新插管是患者结局的主要决定因素。实施教育或质量改进计划有望提高人员对 UE 危险因素的认识，促进安全、标准化的患者护理程序技能，并提高对这些程序的遵守程度。
确定 UE 的危险因素并通过适当的预防策略降低 UE 的发生率，是提高 ICU 护理质量和患者安全的前提条件。
