Objective To develop an intelligent early warning and decision support system for the prevention of unplanned endotracheal extubation (UEE) in adults,so as to prevent the occurrence of extubation events and ensure the safety of patients. Methods A system research and development team was set up to build a UEE early warning and decision support system with 3 modules,including evaluation,early warning,and decision-making. It was applied in the ICU of a tertiary A hospital in Tianjin in September 2020. The researchers compared the implementation rate of UEE preventive measures,the incidence rate of UEE,and the satisfaction of ICU nurses with the system before the application (March-August 2020) and after the application (September 2020-March 2021). Results Compared with the system before application,the implementation of UEE preventive measures by ICU nurses was significantly improved,including risk assessment,endotracheal intubation and fixation,analgesia and sedation observation,norms and constraints,and the differences are statistically significant (P<0.05). No UEE occurred before and after system application. The satisfaction score of ICU nurses on the system is (91.20±7.44) points,which is at a high level. Conclusion The UEE early warning and decision support system can assist ICU nurses to scientifically carry out UEE prevention,improve the implementation rate of UEE preventive measures,and ensure patient safety.