Unplanned Extubation: A Common and Costly Complication of Airway Management

Abstract

Endotracheal intubation and extubation are procedures routinely performed by clinicians who manage the airway of critically ill or injured patients (e.g., emergency physicians, anesthesiologists, and intensive care physicians) and patients undergoing general anesthesia (i.e., anesthesiologists and other anesthesia providers). Most of the time, extubation is a planned, intentional, and controlled event and in these circumstances the rate of complications related to extubation has been reported in the literature to be as high as 12%. The unplanned, unintentional, and uncontrolled removal of the endotracheal tube (ETT) can be either due to actions of the patient removing their own tube, defined as self-extubation, or due to an external force applied to the ETT during nursing care or movement of the patient that causes the dislodgement of the tube, defined as accidental extubation. Unplanned extubation is associated with significant complications, including aspiration pneumonia, hypoxemia, arrhythmias, vocal cord injury, brain damage, and death.