[Accidental extubation in intensive care units: what implications for nursing care?]

Unplanned extubations are defined as unwelcome extubations. The phenomenon is classified in "accidental extubation", if occurring during procedures performed by healthcare workers, or in "self extubation", if the patient removes the endotracheal tube. Unplanned extubations are increasingly being considered an indicator of healthcare quality in ICU. Their rate varies from 3% to 14% of the intensive care units patients, the highest percentages being in burn units (27%). Re-intubations rate varies from 31% to 74%, determining increased length of hospitalisations without affecting mortality rates. Analysis of the local setting is required to improve the safety and quality of care, in order to plan appropriate measures, such as staff education. Preventive strategies include: increasing safety during nursing interventions, research for risk indicators of self-extubation, patient's comfort and sedation protocols, and finally alternative methods to physical and pharmacological restraints. The relationship between unplanned extubations and nursing workload can be used as indicator for the optimization of staff resources in intensive care unit.