• Maged Tanios, Scott Epstein, Mark Grzeskowiak, Huan Mark Nguyen, Hyunsoon Park, and James Leo.
• Maged Tanios is an associate clinical professor of medicine, University of California Irvine, Irvine, California, and director of the medical intensive care unit, Long Beach Memorial Medical Center, Long Beach, California. Scott Epstein is dean for educational affairs and professor of medicine, Tufts University School of Medicine, Boston, Massachusetts. Mark Grzeskowiak is manager, education and quality, Department of Respiratory Care Services, and Hyunsoon Park is a clinical nurse specialist in the intensive care unit, Long Beach Memorial Medical Center. Huan Mark Nguyen is an assistant professor of pharmacy practice, Western University of Health Sciences, College of Pharmacy, Pomona, California. James Leo is medical director, best practice and clinical outcomes, MemorialCare Health System, Fountain Valley, California. mtanios@memorialcare.org.
• Am. J. Crit. Care. 2014 Jul 1;23(4):306-14; quiz 315.

BackgroundIdentifying risk factors for unplanned extubation in patients receiving mechanical ventilation can help guide prevention strategies.ObjectiveTo assess the risk of unplanned extubation with different sedation strategies.MethodsA 36-month quality improvement study in a 33-bed intensive care unit at a tertiary-care center.ResultsA total of 92 unplanned extubations occurred (7.5 events/1000 days of mechanical ventilation): patients who were receiving continuous sedation protocol with daily interruption of sedatives had 1.5 events/1000 ventilator days, patients receiving the intermittent sedation protocol had 5.0 events/1000 days, and patients with no sedation protocol had 16 events/1000 days (P < .05). Median duration of mechanical ventilation before unplanned extubation was 2 days. Most unplanned extubations (94%) were deliberate, and 53% occurred in patients scheduled for weaning. Most unplanned extubations in the continuous sedation protocol group (71%) occurred during weaning, in comparison to the intermittent sedation protocol (54%) and no sedation protocol groups (48%, P< .05). The highest incidences of agitation were in patients receiving the intermittent sedation protocol as compared with the other 2 groups (77% vs 50% vs 49%, P < .05). Overall, 73% of patients who had an unplanned extubation did not require reintubation; those who did were older (mean age: 68 vs 53 years, P = .01) and were male (80% vs 20%, P= .02). Reintubation was unrelated to the time of unplanned extubation.ConclusionStrategies of no sedation or intermittent sedation are both associated with higher rates of unplanned extubation when compared to a strategy of continuous sedation with daily interruption of sedatives. Sedation strategies that allow agitation may increase the risk of unplanned extubation.©2014 American Association of Critical-Care Nurses.

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