title: A retrospective analysis of determinants of self-extubation in a tertiary care intensive care unit.
abstract: BACKGROUND
  Self-extubation is a common event in intensive care units (ICUs) world-wide. The most common factor attributed in various studies is lack of optimal sedation. However, the factors that lead to this inadequacy of sedation are not analyzed.
  
  
  OBJECTIVE
  The present study aimed to evaluate the determinants of factors leading to self-extubation in our ICU. Relation of patient profile, nature of sedation and any diurnal variation in extubation frequency was analyzed.
  
  
  METHODS
  Retrospective explorative analysis was carried out for patients admitted to ICU from January 2011 to January 2012. Information from medical records for the above parameters was extracted and descriptive statistics was used for assessing the outcomes.
  
  
  RESULTS
  In the present study, there was a higher incidence of self-extubation in ventilated ICU patients during the changeover periods of the ICU staff. There was no relation of frequency of self-extubation with the medications used for sedation once the sedation was titrated to a common endpoint. A higher incidence of self-extubation was seen in the surgical and younger age group of patients.
  
  
  CONCLUSIONS
  It is recommended that the duty shift finishing time of ICU staff (medical and paramedical) staff should be staggered and should have minimal overlap to prevent self-extubation. A continuous reassessment of level of sedation of patients independent of the type sedative medication should be carried out.
authors: Department of Anesthesia, All India Institute of Medical Sciences, Delhi, India.
authors: Preet Mohinder
authors: PM
authors: Singh
authors: Vimi
authors: V
authors: Rewari
authors: Chandralekha
authors: Mahesh Kumar
authors: MK
authors: Arora
authors: Anjan
authors: A
authors: Trikha
keywords: Duty shifts intensive care unit staff; sedation in intensive care unit; self-extubation in intensive care unit