Comprehensive strategy for preventing unplanned extubation in patients with post-operative delirium after gastrointestinal surgery

doi:10.4240/wjgs.117179

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 6

This Article

(3)

(2)

(0)

(2)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Jun 27, 2026; 18(6): 117179
Published online Jun 27, 2026. doi: 10.4240/wjgs.117179

Comprehensive strategy for preventing unplanned extubation in patients with post-operative delirium after gastrointestinal surgery

Yan-Hua Yu, Jing-Jing Yang

Yan-Hua Yu, Jing-Jing Yang, Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China

Author contributions: Yu YH is responsible for research design, data collection and analysis, and writing the initial draft of the paper; Yang JJ is responsible for research proposal review, quality control, data analysis guidance, and final paper approval. All authors acknowledge the final manuscript.

Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of Soochow University.

Informed consent statement: All participants provided written informed consent before enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: No additional data are available.

Corresponding author: Jing-Jing Yang, Chief Nurse, Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Gusu District, Suzhou 215000, Jiangsu Province, China. 15606131287@163.com

Received: January 20, 2026
Revised: February 12, 2026
Accepted: March 16, 2026
Published online: June 27, 2026
Processing time: 155 Days and 0.5 Hours

Abstract

BACKGROUND

Unplanned extubation (UE) is a serious complication in patients with post-operative delirium (POD) after gastrointestinal surgery that significantly increases the risk of reintubation, ventilator-associated pneumonia, and mortality. Effective prevention strategies that integrate optimization of sedation-analgesia with structured nursing care are underexplored.

AIM

To determine an individualized sedation-analgesia strategy based on the risk of UE in patients with POD after gastrointestinal surgery.

METHODS

Data from 118 patients with POD who required invasive mechanical ventilation for ≥ 24 hours in the intensive care unit, were retrospectively analyzed. Patients were assigned to an intervention group (n = 60) or a control group (n = 58). Patients in the control group received conventional sedation and single-tape tube fixation, with nursing measures based on clinical experience. Patients in the intervention group had a structured nursing pathway applied that included standardized airway fixation, scheduled delirium assessment, pain monitoring, and early recognition of extubation intention behaviors.

RESULTS

The intervention group had a lower incidence of UE and a composite endpoint of post-reintubation complications than the control group (P < 0.05). Durations of mechanical ventilation, intensive care unit stay, and delirium were significantly shorter in the intervention group (P < 0.05). Multivariate Cox regression analysis showed that increased daily fluctuation in the Richmond Agitation-Sedation Scale score, a higher frequency of extubation intention behaviors, insufficient reduction in interleukin-6, delayed intervention response time, high restraint usage, and low nursing assessment completion rates were independent risk factors for UE (P < 0.05).

CONCLUSION

A combined strategy to prevent UE in patients with POD is proposed, and it effectively reduced the incidence of UE and duration of hospitalization, improved nursing quality, and mitigated neuroinflammation.

Keywords: Post-operative delirium; Unplanned extubation; Gastrointestinal surgery; Sedation-analgesia; Endotracheal tube fixation; Neuroinflammation; Nursing intervention

Core Tip: In this study, a mechanism-oriented strategy (individualized sedation-analgesia + structured nursing) for unplanned extubation in patients with post-operative delirium after gastrointestinal surgery, is proposed. The incidence of unplanned extubation and duration of hospitalization were reduced, and nursing quality was improved, offering a safe model of prevention.