Paper
Tuesday, July 8, 2008
A Meta-Analysis of Unplanned Endotracheal Extubation and Its Related Factors
Yishan Juang1, Hsin-i Huang2, Cihsin Jiang2, You-Shu Han2, and Yueh-Yen Fang, PhD3. (1) Department of Nursing Management, School of Nursing, Fooyin University, Ta-Liao Hsiang, Kaohsiung Hsien, Taiwan, (2) Department of Nursing Management, School of Nursing, Fooyin University, Taiwan, Ta-Liao Hsiang, Kaohsiung Hsien, Taiwan, (3) School of Nursing, Fooyin University, Ta-liao, Kaohsiung, Taiwan
| Learning Objective #1: realize the pooled incidence of unplanned endotracheal extubation in intensive care units. |
| Learning Objective #2: realize the relationships between unplanned endotracheal extubation and the use of narcotics, as well as the use of restraint. |
Unplanned endotracheal extubation (UEE) is a common adverse event in intensive care units. Related studies focused on the discussions of its incidence and risk factors. No report was found to present an integrated result. The purpose of this study was to apply meta-analysis methodology to integrate the study findings of UEE. Random effect models were used to calculate combined effect sizes. Four Chinese and English databases were used to systematically locate both published and unpublished UEE literature up to year 2007. These databases were MEDLINE, CINAHL, as well as two Chinese databases developed by the National Library in Taiwan, the Chinese Journal Database and the Thesis/Dissertation Database. Key words used for literature search were ‘endotracheal', ‘unplanned extubation', ‘ICU', and ‘self-extubation'. Seven studies provided 4,237 samples for the meta-analysis. Meta-analysis results showed that four out of six studies presented consistent incidence of UEE. Based on six studies (4,144 samples), the mean weighted effect size (WES) for the incidence of UEE was 8.2% (95% CI=6.1%-11%, p<.001). The influences of use of narcotics and restraint to UEE were examined based on two studies (218 samples). The comparison in incidences of UEE between patients with and without narcotics use was not significant (mean weighted OR=2.14, 95% CI=.46-9.94, p=.33). The comparison in incidence of UEE between patients with and without restraint was also not significant (mean weighted OR=2.62, 95% CI=.84-8.17, p=.10). Based on five studies (206 samples), the WES for the use of narcotics in UEE patients was 28.6% (95% CI=20.4%-38.4%, p<.001). The use of restraint in UEE patients was inconsistent between Chinese and English literature, but the result was consistent between Chinese studies (Incidence=73.4%, 95% CI=52.4%-87.3%, p=.03). Based on results of this meta-analysis study, more studies are suggested to make conclusion if uses of anesthesia and restraint are effective in preventing UEE.