Challenge 8B

Unplanned Extubation

Extubation is the removal of a patient’s breathing tube. This can occur either in an intentional and controlled manner (Planned Extubation) or in an unintentional and uncontrolled manner (Unplanned Extubation). Most patients have their endotracheal tube removed in an intentional and controlled manner. After successfully completing a spontaneous breathing trial, they are prepared for extubation, their airway is properly suctioned, the cuff is deflated, the tube is removed, and then the patient is oxygenated and monitored to ensure they tolerate the extubation. In 7.3% of intubated mechanically ventilated ICU patients, the tube is removed in an uncontrolled manner before the controlled extubation procedures including a spontaneous breathing trial, suctioning and cuff deflation are completed. Uncontrolled extubation occurs when a patient self-extubates their tube or when the tube is accidentally removed by a force that is exerted on the tube, typically during movement of the patient or during a procedure. All incidences of uncontrolled extubation are associated with an increased risk of complications including vocal cord injury, hypoxemia, brain injury, pneumonia and death. Yet, unplanned extubation is preventable.

Executive summary checklist

Unplanned extubation (UE) is the unintentional removal of a patient’s breathing tube, either by self-removal (self-extubation) or accidental removal due to an external force (accidental extubation) that causes the tube to become dislodged. UE, both in the field and in the hospital, is a common and costly problem. It results
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