Decreasing unplanned extubations in the surgical intensive care unit.
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.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D012121:Respiration, Artificial; D012149:Restraint, Physical