Unplanned extubation usually occurs when a
patient moves his or her hand to reach and pull out
the tube. A 30º elevation of the head of the bed is
common to avoid aspiration and promote ventilation21;
however, such elevation increases the chance
of unplanned extubation. Researchers have suggested
that a patient’s hands should be kept at least 20 cm
away from the tubes,22 and avoiding the head-up
position might prevent unplanned extubation.23
More investigations are needed to develop better
appliances and methods for physical restraint.