降低ICU非計劃性拔管的改善方案

Project of Reducing the Unplanned Extubation of Endotracheal Tubes

目的降低ICU氣管插管病患之非計劃性拔管(unplanned extubation,UEX)率。方法2010年1~5月,發現在73位氣管插管留置病患中,發生UEX 6人次,拔除率為8.2%。分析原因後發現:缺乏適當約束2人次(33.3%),躁動未適當使用鎮靜劑2人次(33.3%),缺乏有效溝通1人次(16.6%),氣囊破裂滑脫1人次(16.6%)。結果由2010年6~10月,在58位氣管插管留置病患中,UEX發生事件下降為3人次,拔除率為5.1%,明顯達到目的。結論充分認識UEX的風險因素、有價值的風險評估指標,對UEX事件進行全面的系統分析,採取預見性的醫療護理措施,是保證患者置管安全、降低UEX發生率的有效手段。

Objective The purpose of this project in ICU patients was to reduce the rate of unplanned extubation tube,(UEX).Methods Form January till May 2010,found in 73 patients tracheal intubation lien,occurring UEX 6 patients,8.2%occurring unplanned extubation.Analytically,the causes of UE were:lack of proper physical restraints in 2 patients(33.3%),no adequate sedation used in 2 irritable patients(33.3%),lack of efficient communication in 1 patient(16.6%),and 1 patient with ruptured cuff(16.6%).Results From June till October 2010,Unplanned extubation ensued in 3 of 58 intubated patients after strategies.The rate of unplanned endotracheal extubation was 5.1%.It reached the goa l of this project successfully.Conclu-sion Fully understanding of the UEX risk factors,valuable risk assessment indexes,the UEX event carries on the comprehensive system analysis,take the foresight of medical care measures,is to guarantee the safety and reduce UEX incidence effective means.