Accidental Extubation Prevention Associated to Nursing Care to High Complexity Patients in Intensive Therapy Unit – Systematic Literature Review

Abstract

Accidental extubation, understood as an adverse event in those patients submitted to mechanical ventilation, is an unplanned removal of the ventilatory device that may happen by self-extubation, when the patient removes the ventilatory device, or by nursing inappropriate management in four moments: bath in the stream bed, endotracheal tube fixation or tracheostomy, transportation and change of decubitus. This kind of incident, when associated to nursing care, causes serious complications to the patient who is, eventually, sedated or in coma, motivating reintubation or other complications, as well death, occasioned by unsuccessfull execution of that. In case of removal performed by the patient himself, the necessity of reintubation will vary according to patient’s clinical status in the exact moment of the occurrence. This study intends to analyze articles published on national and international scientific journals, concerning the circumstances of higher incidence rates of accidental extubation and preventive measures, related to nursing care. It’s a systematic review of scientific literature, with qualitative approach, in what PUBMED E BDENF eletronic database is used, temporally limited to the period from 2003 to 2008. For this study, 10 articles were selected and analyzed. One concludes that accidental extubation is widely focused, poorly directed to preventive measures, but to its related factors and consequences. It shows how preventive measures are necessary, including staff constant education.