Background Unplanned extubation (UE) is associated with prolonged duration of mechanical ventilation and ICU and hospital stay. Although UE has been studied regularly, many questions about incidence, determinants, and outcomes have not been answered in details. Moreover, inconsistent findings exist regarding outcomes. This study aimed at defining risk factors associated with UE with respect to consequences in relation to reintubation and mortality. Patients and methods Invasively mechanically ventilated patients were enrolled and classified into planned extubation and UE groups according to the type of extubation. All patients were subjected to calculation of Simplified Acute Physiology Score on admission and Glasgow Coma Score, observed for presence of agitation, wrist restrains, use of sedation, and degree of sedation using Ramsay Sedation Score. Duration of mechanical ventilation before UE, patient-to-nurse ratio, timing of UE, total ICU length of stay, and mortality were recorded. Satisfaction question was applied to both responsible nurse and resident. Results Overall, 11.02% of the studied patients experienced UE. UE was more prevalent in patients who were physically restrained, agitated, less sedated, with lower Ramsay score, and with unsatisfied loaded nurses and junior resident who were unsatisfied. In all, 55.6% of UE occurred in night shifts. UE had prolonged length of stay (13.28±3.92 days), higher reintubation rate (44.5%), and higher mortality (29.6%). Conclusion This work identified four independent risk factors for UE: agitated patient, managed by a junior resident and loaded nurse particularly in a night shift.