减少外科重症监护病房的非计划拔管情况。

Decreasing unplanned extubations in the surgical intensive care unit.

作者信息

Tominaga G T, Rudzwick H, Scannell G, Waxman K

机构信息

Department of Surgery, University of California Irvine Medical Center, Orange 92668, USA.

出版信息

Am J Surg. 1995 Dec;170(6):586-9; discussion 589-90. doi: 10.1016/s0002-9610(99)80021-x.

DOI:10.1016/s0002-9610(99)80021-x

PMID:7492006

Abstract

BACKGROUND

Unplanned extubations are common, but can be life-threatening.

METHODS

We conducted a prospective evaluation of all intubated patients in our surgical intensive care unit to examine the effects of three parameters on the likelihood of accidental extubation. The parameters were the method of endotracheal tube fixation, the use of sedation/paralysis, and the use of hand restraints. During the baseline period, tubes were secured with cloth or velcro ties, sedation was used conservatively, and hand restraints were used routinely. A change in one study parameter was made prior to each period. Thus, in period II, tubes were secured using waterproof tape; in period III, tubes were secured with waterproof tape and sedation/paralysis was used liberally; and in period IV, tubes were secured with waterproof tape and limited use was made of hand restraints.

RESULTS

Accidental extubations were significantly less frequent when tubes were secured with waterproof tape (P < 0.0001). No difference was seen when sedation was instituted liberally. Restricted use of hand restraints was associated with significantly increased accidental extubations (P < 0.001).

CONCLUSIONS

Our data support the use of water resistant tape to secure endotracheal tubes and the routine use of hand restraints.

摘要

背景

意外拔管很常见，但可能危及生命。

方法

我们对手术重症监护病房的所有插管患者进行了前瞻性评估，以研究三个参数对意外拔管可能性的影响。这些参数是气管内导管固定方法、镇静/麻痹的使用以及手部约束的使用。在基线期，导管用布或尼龙搭扣带固定，镇静使用保守，手部约束常规使用。在每个时期之前对一个研究参数进行改变。因此，在第二期，导管用防水胶带固定；在第三期，导管用防水胶带固定并大量使用镇静/麻痹；在第四期，导管用防水胶带固定并限制使用手部约束。