{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:56:29Z","timestamp":1791179789518,"version":"4.1.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[1998,4,1]],"date-time":"1998-04-01T00:00:00Z","timestamp":891388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The predisposing factors and complications of unplanned extubation (UEX) in mechanically ventilated adult patients are not well recognized. We designed a prospective multicenter observational study to identify risk factors and describe the complications of UEX. We followed 426 ventilated patients over a 2-mo period. Clinical characteristics such as diagnosis on admission and reasons for ventilation were used to classify the patients. The presence or absence of potential risk factors was daily noted, including the types of ventilators, tracheal tubes, tube fixations, ventilatory support modes, route for intubation, and the use of intravenous sedation. Circumstances and complications of UEX were prospectively recorded. Forty-six (10.8%) patients experienced at least one episode of UEX. Ten UEX occurred during nursing procedures. At the moment of UEX, 61% of patients were agitated. The rates of mortality, laryngeal complications, nosocomial pneumonia after extubation, and the length of mechanical ventilation were similar in UEX and non-UEX patients. Patients were more often reintubated after UEX (28 of 46) than after planned extubation (28 of 284). All the non-reintubated UEX patients survived. One death occurred as a direct consequence of UEX. By use of multivariate analysis, we identified four factors contributing to UEX: chronic respiratory failure, endotracheal tube fixation with only thin adhesive tape, orotracheal intubation, and the lack of intravenous sedation. Considering these factors, we hypothesized that simple measures should be adopted to minimize the incidence of UEX and its related complications: more vigilance during procedures at patients' bedsides, adequate sedation of agitated patients, strong fixation of the tracheal tube, particular attention paid to orally intubated patients, and daily reassessment of the possibility of weaning from the ventilator.<\/jats:p>","DOI":"10.1164\/ajrccm.157.4.9702083","type":"journal-article","created":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T13:35:05Z","timestamp":1365082505000},"page":"1131-1137","source":"Crossref","is-referenced-by-count":176,"title":["Unplanned Extubations in the Adult Intensive Care Unit: A Prospective Multicenter Study"],"prefix":"10.1093","volume":"157","author":[{"given":"THIERRY","family":"BOULAIN","sequence":"first","affiliation":[{"name":"Service de R\u00e9animation M\u00e9dicale, Centre Hospitalier Universitaire Bretonneau, Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[1998,4,1]]},"reference":[{"key":"2026032709144549200_B1","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1378\/chest.98.1.165","article-title":"Self-extubation: a 12-month experience.","volume":"98","author":"Coppolo","year":"1990","journal-title":"Chest"},{"key":"2026032709144549200_B2","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1007\/BF01694708","article-title":"Prospective evaluation of self-extubations in a medical intensive care unit.","volume":"19","author":"Vassal","year":"1993","journal-title":"Intensive Care Med."},{"key":"2026032709144549200_B3","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1097\/00000542-197807000-00016","article-title":"Spontaneous dislocation of endotracheal tubes.","volume":"49","author":"Ripoll","year":"1978","journal-title":"Anesthesiology"},{"key":"2026032709144549200_B4","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1378\/chest.105.6.1804","article-title":"Unplanned extubations.","volume":"105","author":"Tindol","year":"1994","journal-title":"Chest"},{"key":"2026032709144549200_B5","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/00003246-199002000-00007","article-title":"Factors affecting accidental extubations in neonatal and pediatric intensive care patients.","volume":"18","author":"Little","year":"1990","journal-title":"Crit. 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VIII\u00e8me Conf\u00e9rence de Consensus en R\u00e9animation, Lille, France, Juin 1991.","volume":"1","author":"Gibert","year":"1992","journal-title":"R\u00e9animation Urgences"},{"key":"2026032709144549200_B13"},{"key":"2026032709144549200_B14","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/0002-9343(74)90440-9","article-title":"Complications of assisted ventilation: a prospective study of 354 consecutive episodes.","volume":"57","author":"Zwillich","year":"1974","journal-title":"Am. J. Med."},{"key":"2026032709144549200_B15","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/00003246-198006000-00002","article-title":"Complications of airway intrusion in 100 consecutive cases in a pediatric ICU.","volume":"8","author":"Orlowski","year":"1980","journal-title":"Crit. 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