I read with interest the article by Chang et al1 in the September 2008 issue. In this retrospective study, the authors viewed the relationship between unplanned extubations and restraints and the contributing risk factors. As a critical care nurse, I have been faced with this problem; whenever a patient self-extubates, health care providers must act quickly. As the authors note, 37% to 57% of these patients must be reintubated within the first hour, and 37% to 57% within 48 hours.

Ideally, the patient’s medical team would be the ones to decide when he or she should be extubated, but whenever a patient self-extubates, there is much concern and self-recrimination by the nurse caring for that patient. The nurse is aware of the many risks involved, such as tearing of the larynx, anoxia, or even death. These concerns could account for the frequent...

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