Published online Jun 27, 2026. doi: 10.4240/wjgs.117179
Revised: February 12, 2026
Accepted: March 16, 2026
Published online: June 27, 2026
Processing time: 148 Days and 7.6 Hours
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.
To determine an individualized sedation-analgesia strategy based on the risk of UE in patients with POD after gastrointestinal surgery.
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.
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).
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.
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.