A Prospective Evaluation of Unplanned Endotracheal Extubations in a Pediatric Intensive Care Unit (Picu)

Decreasing unplanned extubations: Utilization of the Penn State Children’s Hospital Sedation Algorithm

“…Figure 2 demonstrates that our pre-PSCHSA extubation rates were comparable to published rates, and our post-PSCHSA extubation rates were superior to or equal to all published rates (3)(4)(5)(6)(7)(8).…”

“…The hypothesized primary mechanism for this decrease was increased diligence to the details of patient care. In the following 5 yrs, that level reached a stable but unacceptable plateau (0.44 to 0.63 per 100 intubated patient days), which was superior to or equal with published data (3)(4)(5)(6)(7)(8). However, the decision was made that improvements in patient management were necessary to further decrease the unplanned extubation rate because the critical care team considered even a single unplanned extubation as unacceptable due to the potentially dangerous results.…”

Experience with intubated patients does not affect the accidental extubation rate in pediatric intensive care units and intensive care nurseries

“…Rates of accidental extubation have been reported from a wide range of institutions. [1][2][3][4][5][6][7][8][9][10] We conducted a prospective study of the rate of accidental extubation in the PICU at Washoe Medical Center in Reno, Nevada. The PICU at Washoe Medical Center is a combined intensive care and observation unit with six beds.…”

Pain status and sedation level in Chinese children after cardiac surgery: an observational study

“…2004) and can cause withdrawal symptoms (Tobias 2000). On the other hand, inadequate sedation may result in potentially dangerous outcomes, such as accidental extubation, removal of other critical mechanical devices, physiological instability and physical harm including tracheal stenosis or hypoxia because of the agitated state of the child (McCready et al. 1994, Meneghini et al.…”

“…However, excessive sedation can necessitate prolonged MV and length of stay (LOS) in the ICU (Kollef et al 1998, James & Scuplak 1999, Ostermann et al 2000, Schweickert et al 2004) and can cause withdrawal symptoms (Tobias 2000). On the other hand, inadequate sedation may result in potentially dangerous outcomes, such as accidental extubation, removal of other critical mechanical devices, physiological instability and physical harm including tracheal stenosis or hypoxia because of the agitated state of the child (McCready et al 1994, Meneghini et al 2000. It is important for healthcare professionals to conduct accurate sedation assessments to avoid over-or under-sedation, so that this practice can positively influence the child's recovery.…”