title: The role of standardized protocols in unplanned extubations in a medical intensive care unit.
abstract: BACKGROUND
  Many patients admitted to medical intensive care units require mechanical ventilation to assist with respiratory management. Unplanned extubations of these patients are associated with poor outcomes for patients and organizations. No previous research has investigated the role of standardized protocols in unplanned extubations when examined in conjunction with traditional risk factors.
  
  
  OBJECTIVE
  To identify risk factors associated with unplanned extubation among patients receiving mechanical ventilation and determine degree of compliance with pain, sedation, and weaning protocols.
  
  
  METHODS
  A prospective cohort study design was used. Data on all patients admitted to the medical intensive care unit who required mechanical ventilation were gathered daily. Additional data were gathered on those patients who experienced unplanned extubation. Descriptive, correlational, and regression analyses were performed.
  
  
  RESULTS
  Weaning protocols were a significant predictor of unplanned extubation: patients who had weaning protocols ordered and followed were least likely to experience unplanned extubation. Only 10% of the 190 patients in the study required reintubation, resulting in a significantly shorter ventilation time and unit length of stay among the unplanned extubation group.
  
  
  CONCLUSIONS
  Weaning protocols were associated with decreased incidence of unplanned extubation. Use of standardized protocols was feasible, as compliance among health care providers was high when protocols were medically prescribed. The reintubation rate in this study was low and associated with a significantly shorter ventilatory period and unit length of stay in the unplanned extubation group.
authors: Department of Nursing, MetroHealth Medical Center, Cleveland, Ohio 44109, USA.
authors: Mary
authors: M
authors: Jarachovic
authors: Maggie
authors: M
authors: Mason
authors: Kathleen
authors: K
authors: Kerber
authors: Molly
authors: M
authors: McNett
mesh_terms: D000368:Aged; D015331:Cohort Studies; D020878:Device Removal / Q000592:standards*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007442:Intubation, Intratracheal / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009820:Ohio; D012121:Respiration, Artificial / Q000379:methods / Q000592:standards*; D012131:Respiratory Insufficiency / Q000628:therapy; D012307:Risk Factors; D015300:Ventilator Weaning / Q000592:standards*