Prevention of unplanned endotracheal extubation in intensive care unit: An overview of systematic reviews.
Jinhua Wu, Zhili Liu, Danqiao Shen and 4 others
PMID 35971250WHAT IT FOUND
Psychological care, root cause analysis, and continuous quality improvement are supported for reducing unplanned extubation in ICU patients.
Restraint alone is not proven, and no best tube fixation method exists.
Key findings
01Psychological care and root cause analysis were each reported to reduce unplanned extubation incidence.
02Restraint alone was not effective, and in patients with GCS above 9 it increased unplanned extubation risk 6.16 times.
03Continuous quality improvement was reported to reduce unplanned extubation in adults and children, but no optimal tube fixation method was established.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The evidence came from reviews of reviews, not directly from patients, so weaknesses in the included reviews can affect the conclusions. The included original studies were all published in 2018 or earlier, so newer ICU practice may not be represented. The reviews were too heterogeneous to combine into a single effect estimate, so the overview does not show how much any one measure reduces unplanned extubation. Psychological care was supported, but specific care methods were not described well enough to act on. No UEE risk assessment tool or assessment frequency was identified. Several included reviews did not assess publication bias or did not support recommendations with reported data.
Declared interests
The declared funding source is the Shantou Science and Technology Project.
The easy way to misread this
Do not conclude that physical restraint prevents unplanned extubation. Restraint alone was not effective, and one review found increased risk in patients with higher GCS scores.