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Updated: Jun 19, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Unplanned extubation in pediatric critically ill patients: a systematic review and best practice recommendations
Paulo Sérgio Lucas da Silva1, Werther Brunow de Carvalho
1Division of Pediatric Critical Care Medicine, Universidade Federal de São Paulo, São Paulo. psls.nat@terra.com.br
Insights
Unplanned extubations in pediatric intensive care units are reduced by quality improvement programs. Key risk factors include younger age and inadequate tube fixation, necessitating updated prevention strategies.
Area of Science:
- Pediatric critical care medicine
- Patient safety research
- Quality improvement science
Background:
- Unplanned extubation (UE) is a significant concern in pediatric intensive care units (PICUs).
- Existing literature on UE incidence, risk factors, and prevention strategies requires updating.
- Understanding UE is crucial for enhancing patient safety and clinical outcomes.
Purpose of the Study:
- To synthesize current knowledge on unplanned extubations in pediatric populations.
- To identify incidence rates, risk factors, and reintubation risks associated with UE.
- To summarize and propose evidence-based best practices for UE prevention.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (MEDLINE, CINAHL, Scielo, Lilacs, Cochrane) from 1966 to 2009.
- Keywords included various terms for unplanned extubation and treatment interference.
- Eleven pediatric studies were selected based on predefined eligibility criteria and assessed for quality.
Main Results:
- UE incidence ranges from 0.11 to 2.27 events per 100 intubation days.
- Risk factors for UE include younger age, inadequate endotracheal tube fixation, patient agitation, and high nursing workload.
- Reintubation rates following UE vary widely (14%–65%); quality improvement programs show significant reductions in UE rates.
Conclusions:
- High-quality studies demonstrate that implementing quality improvement components effectively reduces UE rates in PICUs.
- While rigorous research is ongoing, current evidence supports specific recommendations for UE prevention.
- Further studies are needed to establish definitive guidelines for preventing unplanned extubations in pediatric critical care.
Objective:
The aim of this study was to update the state of knowledge of unplanned extubations in the pediatric population. The main topics addressed in the current literature on unplanned extubations were: 1) incidence; 2) risk factors; 3) risk factors for reintubation after unplanned extubations; and 4) strategies to prevent unplanned extubations. Based on this review we summarize and propose best practices in preventing unplanned extubations.
Data Source:
MEDLINE, CINAHL, Scielo, Lilacs, and Cochrane databases were searched for bibliography for the period spanning from January 1966 to March 2009. We used the following key words: unplanned extubation, accidental extubation, self extubation, unintentional extubation, unexpected extubation, inadvertent extubation, spontaneous extubation, and treatment interference.
Study Selection:
Eleven pediatric articles were eligible for data abstraction. Study quality was assessed using four levels of aggregate evidence adapted from the American Academy of Pediatrics.
Data Synthesis:
Unplanned extubations occurs at a rate of 0.11 to 2.27 events per 100 intubation days. Risk factors associated with unplanned extubations were age (younger patients), inadequate tube fixation, agitation, copious secretions, performance of patient procedures, and nursing workload. Reintubation rates ranged from 14% to 65% of unplanned extubations. Three cohort studies evaluated the effectiveness of strategies in reducing unplanned extubations. One study reported the institution of a standardized algorithm of goal-directed sedation, whereas two studies evaluated the implementation of a continuous quality-improvement program. These studies reported significant reductions in unplanned extubations rate after program implementation. Methods of securing the endotracheal tube varied across studies and the use of physical restraints yielded conflicting findings.
Conclusions:
There are few studies assessing unplanned extubations in pediatric intensive care units. The available quality studies have shown that improvement of quality components is effective in reducing unplanned extubations. Although further rigorous studies are needed to establish strong recommendations on unplanned extubations prevention, we present a summary of recommendations based on review of the current literature.
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