Self-Extubation in the Surgical Intensive Care Unit and Restraint Policy Change: A Retrospective Study

Background: Self-extubation is a serious complication of mechanical ventilation. The incidence of self- extubation in a university hospital may be altered by a recent policy change, which requires daily written and face-to-face patient re-evaluations regarding the need for restraints in the intensive care units. There are many concerns and suspicions that this might result in less use of restraints and thereby increase the risk of self-extubation. Methods: The goal of this study was to describe the incidence of self-extubation (SE) over time and report any observed change with the change in restraint policy (RP). Results: The rate of self-extubation during the control year was 1.62% which increased to 2.33% during the initial study period and decreased to 1.30% in the following year. The distant follow-up period eight years after the initial change in restraint policy showed a rate of 1.14%. Apache scores did not differ significantly between the years compared. Conclusion: A new restraint policy, which requires frequent reordering by physicians, has the potential to be associated with increased self-extubation, at least temporarily. Staff education may help reduce this risk. Further research will be useful in clarifying which interventions can most reduce this potentially life-threatening complication.