https://doi.org/10.4081/ecj.2026.15693
Unplanned extubation in adult patients: a narrative review of modifiable and non-modifiable risk factors
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Published: 3 July 2026
Unplanned Extubations (UE) are adverse events of relevant clinical significance, with an incidence ranging from less than 1 per 100 ventilator-days in high-volume academic settings to 19.74% in low-resource referral hospitals. This narrative review, conducted according to SANRA criteria, analyzed 7 studies published between 2021 and 2026 with the aim of identifying clinical, care-related, and organizational factors associated with unplanned removal of airway management devices in adult patients. Three thematic macro-areas were identified: patient-related factors (agitation, physical discomfort, male sex, short intubation duration, use of physical restraints); technical and clinical factors related to the device and its management (endotracheal tube positioning, event timing in relation to shift changes and direct nursing procedures); and organizational and professional factors (nurse-to-patient ratio, staff experience, cognitive continuity during care transitions). The results confirm the multifactorial nature of the phenomenon and highlight two significant gaps in the existing literature: the systematic absence of nursing experience as an independent variable, despite nurses representing the professionals with the highest direct patient contact time; and the exclusive focus on intensive care settings, with a near-total lack of data on rehabilitation and sub-intensive wards, where the progressive increase in tracheostomized patients makes unplanned device removal potentially even more critical. Future research should adopt standardized definitions, prospective multicenter designs, and explicitly include the nursing experience variable, extending the scope to non-intensive care settings.
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Ethics Approval
CRediT authorship contribution
Ruben Gorla conceived the research question, defined the study objectives, and was responsible for the original drafting of the manuscript, including the narrative synthesis and interpretation of findings. Valentina Sciara led the construction of the search strategy, coordinated the literature search across all three databases, and supervised the methodological application of SANRA criteria throughout the review process. Both authors independently performed title and abstract screening; disagreements were resolved through discussion and, where necessary, full-text reading. Full-text evaluation and data extraction were performed jointly. Both authors contributed to the critical revision of the manuscript for important intellectual content and approved the final version.
Data Availability Statement
All data generated or analyzed during this study are included in this published article.
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