Bambi Stefano, Rodriguez Samuele Baldassini, Lumini Enrico, Lucchini Alberto, Rasero Laura
Assist Inferm Ric. 2015 Jan-Mar;34(1):21-9. doi: 10.1702/1812.19748.
Unplanned extubations (UEs) in adult Intensive Care Units (ICUs), have recently become an indicator of quality and safety of care.
A literature review published 10 years ago was updated to analyze any changes in UEs.
The cumulative incidence of UEs varied between 0.3% and 27%, before 2000, and more recently, from 0.5% to 35.8%, without substantial changes. The rate of Self Extubations (SE) outweighed the Accidental Extubation (AE), amounting to 50%-100% of all UE. The reintubations rate ranged between 1.81% and 88%. The UEs increase the length of the mechanical ventilation, of ICU and hospital stay, and according to few studies the rate of death with UEs is lower. Major risk factors for UE are: APACHE II score ≥17, agitation, physical restraints, administration of midazolam, and higher levels of consciousness. The implementation of ABCDE bundle in ICUs did not involve additional risks of UE. The prevention includes a sedation with drugs different from benzodiazepines, an early detection of patients' readiness to weaning trial from mechanical ventilation, and the adequate stabilization of the endotracheal tube, with securing systems passing behind the patient's neck. The use of physical restraints is inconsistent, since it can be a risk factor for SE.
For preventing UEs the surveillance of nursing staff is fundamental, if the staffing is adequate to the real workloads in ICU.
成人重症监护病房（ICU）中的非计划拔管（UEs）最近已成为护理质量和安全的一个指标。
更新了10年前发表的一篇文献综述，以分析UEs的任何变化。
2000年前UEs的累积发生率在0.3%至27%之间，最近则在0.5%至35.8%之间，无实质性变化。自行拔管（SE）的发生率超过意外拔管（AE），占所有UE的50%-100%。重新插管率在1.81%至88%之间。UEs会增加机械通气时间、ICU住院时间和医院住院时间，且根据少数研究，UEs患者的死亡率较低。UE的主要风险因素包括：急性生理与慢性健康状况评分系统（APACHE II）≥17分、躁动、使用身体约束、使用咪达唑仑以及意识水平较高。在ICU实施ABCDE集束化治疗并未增加UE的额外风险。预防措施包括使用非苯二氮䓬类药物进行镇静、早期发现患者准备好进行机械通气撤机试验以及通过将固定系统置于患者颈部后方来充分固定气管插管。身体约束的使用并不一致，因为它可能是SE的一个风险因素。
为预防UEs，护理人员的监测至关重要，前提是人员配备要与ICU的实际工作量相匹配。
