The Assessment Of The Risk Factors And Preventive Strategy For Unplanned Endotracheal Extubation In Adult Patients:Systematic Review

Objective:To assess of the risk factors and preventive strategy for unplanned endotracheal extubation in adult patients through the retrieving,scoring and systematic review of related articles,and provide the basis for the assessment and intervention of unplanned endotracheal extubation in clinic.Medthods:The analysis is conducted by means of retrieval of the published data of Cochrane,PubMed,SCOPUS,CINAHL,EBSCO,MEDLINE,CBM,CNKI,and Wanfang database.The time limit of retrieval is from Jan 1st,2015 to Jan 31st,2017.The related systemic review and Meta analysis in database of Cochrane,the related original articles in other database are explored.The titles,abstract,key words,subject terms and references of above articles are analyzed and the key words for literature retrieval are determined.Combined with subject terms and freedom terms,referred to the retrieved documents in time and then expand synonymous terms.The determined key words for retrieved in English:(unplanned extubation or unexpected extubation or unscheduled extubation or unintended extubation or inadvertent extubation or unintentional extubation or self-extubation or airway accident)and(mechanical ventilation or artificial respiration or intubation);The key words for retrieval in Chinese:(unplanned extubation or unexpected extubation or self-extubation).The retrieval results are screened strictly and the literatures meeting requirements are chosen finally.The level and quality of the literatures were evaluated using U.S.Hopkins Level of Evidence and Quality Evaluation Method by two evaluators independently,and then the data are collected and analyzed.Results:The results of the level and quality evaluation about 50 literatures included in this study:1 literature is Level IB;1 literature is Level IIA;6 literatures are Level ?B;31 literatures are Level IIIA;7 literatures are Level IIIB and 4 literatures are Level IVA.The risk factors and preventive strategy for unplanned endotracheal extubation in adult patients are raised by systematic review.The risk factors include patient related risk factors,such as stir/delirium,consciousness level,disease types and severity,other factors(APACHE II,male);Care related risk factors such as the fixed methods of endotracheal tube,reducement of bedside monitoring,nursing procedures,proportion of nurses and patients and nursing experience;Sedation related risk factors:insufficient sedation and sedative drugs;The constraints of body;Higher risk period of unplanned endotracheal extubation.The preventive strategies include the employee's education strategy,risk factors assessment strategy,fixed methods and monitoring strategy of endotracheal tube,sedation and analgesia protocol strategy,ventilator agreement strategy,constraints of body strategy and management strategy.Conclusion:The methods for the risk factors assessment and preventive strategies of unplanned endotracheal extubation in adult patients are established,which are effective measures to reduce the incidence of unplanned endotracheal extubation.