Unintentional or accidental extubation is an undesirable complication in the mechanically ventilated patient. This is particularly dangerous in high-risk patients who are on neuromuscular blocking agents or positive end-expiratory pressure or are difficult to reintubate. This article identifies some of the factors resulting in intentional extubation as well as measures taken to prevent them. A protocol was developed and utilized in Catholic Medical Center. The results of a two-year study reveal a reduction of the incidence from an initial 12% to 5% and a reduction of high-risk extubations from five to an incidence of three. The investigator also assembled an airway system consisting of low pressure cuff endotracheal tube with a pressure monitoring device and several adapters along with a tube fixation system.