Background Unplanned extubation is associated with adverse outcomes in intensive care unit.The massive burn patient differs from other critically ill patients in many ways.However,little is known about the unplanned decannulation (UD) in Burn Intensive Care Unit.This paper describes the special features of the circumstances and outcome of UD of tracheotomy tube in massive burn patients.Methods A case series study was performed between January 1999 and December 2008 and UD of tracheotomy tube was analyzed retrospectively.A total of 21 patients with 29 UD events were identified.Demographic data,diagnosis,intervention,UD events and outcome of UD patients were collected.Differences in proportions were compared using the chi-square (X2) or Fisher's exact test.Results Patients with UD were often burned with head and neck (67％) and combined with inhalation injury (62％).The majority of them (76％) were transferred patients,occurred early (55％) and were accidental UD (79％).UD events tended to happen in day shift (90％) and to be associated with the medical procedure that was performing by caregivers at besides (79％).Loose of the stabilizing rope,medical procedure and tracheotomy malposition were the main causes of UD.Early UD and reintubation failure were associated with patients' death.Conclusions UD happened to massive burn patients can lead to patient death.Careful management of respiratory tract was essential for massive burn patients.