Unplanned Extubation
Common. Costly. Preventable.

In health care, a significant threat to ventilated patient safety is Unplanned Extubation, which occurs when a patient or other external force pulls an inadequately stabilized breathing tube out of the airway (7,11,41,42).

Every year, unplanned extubation impacts more than 121,000 patients, causes over 36,000 cases of ventilator-associated pneumonia, leads to more than 33,000 preventable deaths, and adds more than $4.9 billion in wasteful healthcare costs. The median incidence rate of Unplanned Extubation is 7.3% in all ventilated ICU patients (7,11,41,42). As the current standard of care, this is unacceptable.

It Starts with Securement

Unplanned extubation can only occur when an endotracheal tube is inadequately secured, allowing forces, either applied by the patient (self-extubation) or externally applied by other than the patient (accidental extubation), to dislodge the tube out of the trachea (20,21). Current securement practices fall into two broad categories.

Tape, Adhesive, or Twill Securement

The first category of securement practices utilizes tape. Cotton twill tape is “tied” around the endotracheal tube and then anchored around the patient’s neck. Adhesive tape is adhered to the patient’s cheeks or wrapped around the patient’s neck.

Commercial Device Securement

The second category of securement practices utilizes commercial devices specifically designed to secure endotracheal tubes via any one of a number of mechanical methods that grip, squeeze, or adhere to the tube while also facilitating ease of application and improved oral care while minimizing pressure-induced skin and oral mucosa injuries. Device effectiveness is typically measured by its ability to hold the endotracheal tube in place against the greatest amount of force, ease of application, and the ability to minimize pressure damage the device causes to oral mucosa, lips, and facial skin (20,22).

Unplanned Extubation increases with the following factors:

Patient restlessness/agitation (7)
Inadequate sedation (10,37)
Use of physical restraints (37)
Absence of clear policies and procedures related to weaning (10)
Factors related to nursing staffing such as night shift, inexperienced ICU nurses, or unit characteristics that prevent adequate nursing observation (7)

Unplanned Extubation in the Perioperative Environment
by Lauren Berkow, MD, FASA, and Arthur Kanowitz, MD, FACEP
Read the paper ➞

A Significant Clinical Burden

A comprehensive review of the literature reported that unplanned extubation occurs in 7.3% (median) of all adult ICU intubated patients with a range of UE rates among the fifty studies included in the review of 0.5% - 35.8% (7). A similar significant clinical burden occurs in all age groups:

Rates of Unplanned Extubation in the ICU

The majority (62.8%-96.4%) of unplanned extubations in adult intensive care units are the result of patient self-extubation (3,5,11,13).

Number and Cost of Unplanned Extubation Yearly in US ICUs

Do it for Drew

Drew Hughes was an active, vibrant 13-year-old boy from North Carolina. In June of 2013, Drew was out skateboarding with his friends and fell backward, striking his head on the pavement. After visiting the local emergency department, the decision was made to transport Drew to the Level I Trauma Center. He was alert and conscious in the Emergency Department, but as a safety precaution the medical staff recommended Drew be sedated and a life sustaining breathing tube be placed in his airway for the long transport.

En route to Vidant Medical Center in Greenville, Drew woke up in the ambulance and removed the breathing tube from his airway–an event called unplanned extubation. The paramedics responded by injecting Drew with a medication to paralyze him so they could replace the breathing tube before continuing the transport. Over the next 30 minutes, Drew’s oxygen levels fell dramatically because his breathing tube had been improperly positioned in his esophagus rather than his trachea. As a result, Drew lost his life. If Drew’s breathing tube had been adequately stabilized, this preventable tragedy would never had occurred.

We believe one death is too many. That’s why Securisyn Medical is partnering with The Do It For Drew Foundation, Airway Safety Movement, and the Patient Safety Movement Foundation to raise awareness and eliminate preventable deaths from unplanned extubation.

Unfortunately, Drew’s story isn’t unique. Unplanned Extubation is affecting patients and hospitals around the country every day. And sometimes, UE even makes headlines.

READ UE STORIES

Prevention is Possible

Prevention of unplanned premature extubation begins with securement. As noted above multiple authors have described the absence of an optimal endotracheal tube stabilizer for patients of any age (15,20-22,24-26,28,30,34,54-56).

Attributes of the optimal securement device include:

Easy application and maintainence
Adequate stabilization of the tube against external forces that risk dislodgement
Prevention of tube movement >3.5 cm
Security is not compromised when the device is exposed to blood, saliva, or other fluids
Secures the endotracheal tube without compressing the tube and decreasing the internal diameter
Enables movement of the tube in the mouth for oral care and ulceration prevention without jeopardizing the position of the distal tip
Facilitates suctioning of the tube and oropharynx without risk of tube movement
Allows good visualization of the oral cavity
Requires infrequent adjustment or change

Learn how you can get involved in tracking, preventing, and eliminating Unplanned Extubation.

The Modern Solution

Our portfolio of novel securement devices are designed to reduce the complications of unplanned extubation.

Learn more

Unplanned Extubation Common. Costly. Preventable.