DECREASING UNPLANNED EXTUBATIONS IN THE SURGICAL INTENSIVE-CARE UNIT

BACKGROUND: Unplanned extubations are common, but can be life-threaten ing. METHODS: We conducted a prospective evaluation of all intubated p atients in our surgical intensive care unit to examine the effects of three parameters on the likelihood of accidental extubation. The param eters were the method of endotracheal tube fixation, the use of sedati on/paralysis, and the use of hand restraints. During the baseline peri od, tubes were secured with cloth or velcro ties, sedation was used co nservatively, and hand restraints were used routinely. A change in one study parameter was made prior to each period. Thus, in period II, tu bes were secured using waterproof tape; in period III, tubes were secu red with waterproof tape and sedation/paralysis was used liberally; an d in period IV, tubes were secured with waterproof tape and limited us e was made of hand restraints. RESULTS: Accidental extubations were si gnificantly less frequent when tubes were secured with waterproof tape (P <0.0001). No difference was seen when sedation was instituted libe rally. Restricted use of hand restraints was associated with significa ntly increased accidental extubations (P <0.001). CONCLUSIONS: Our dat a support the use of water resistant tape to secure endotracheal tubes and the routine use of hand restraints.