Dados do Trabalho

Título

Preventing Unplanned Extubations: Impact of a Targeted Care Bundle in Critical Care

Objetivo

To present a care plan developed at our institution aimed at preventing unplanned extubations.

Métodos

This plan was implemented in 2019 in a 64-bed ICU at a quaternary hospital in São Paulo, Brazil. A structured protocol was developed to reduce the incidence of unplanned extubations. The action plan includes the identification and recognition of risk factors for UE, such as agitation during awakening, delirium, psychomotor agitation, use of hallucinogenic medications, history of alcohol or drug abuse, and previous accidental extubation. The protocol introduces a comprehensive care "bundle" that involves: visual bedside risk alerts for the multidisciplinary team and family, double fixation of the orotracheal tube, daily review during multidisciplinary rounds to optimize sedation and medication, careful mobilization during procedures, use of restraint gloves, continuous monitoring, and engaging family members as partners in care.

Resultados

Since the implementation of this care bundle, the mean incidence density of unplanned extubation in our ICU has been 0.24 events ((unplanned extubation/total extubation) x 100), which is significantly lower than the values reported in the literature.

Conclusão

The implementation of a multidisciplinary care bundle, combined with active family involvement, has proven effective in reducing the risk of unplanned extubations in critically ill patients.