Accidental extubations during respiratory management in a children’s hospital

Abstract

An investigation was conducted on the frequency of accidental extubations at Shizuoka Children's Hospital during the past 12 years. The study was performed on 150 randomly selected patients who received respiratory support for more than 24 hr. Fifteen accidental extubations occurred in 9 patients. Most of them (87%) occurred in the neonatal intensive care unit (NICU), and the rate was 1 per 54 days of intubation. The time at which these accidents happened varied, although they were more common during the day-time. The reasons of accidental extubation could not be specified in two-thirds of the cases. It became clear that more immature babies were more likely to suffer accidental extubation, perhaps reflecting the fact that most of the immature babies in the NICU were intubated orally, and that a larger proportion of them required a longer period of respiratory support. Therefore, early weaning from respiratory support is recommended if it is possible. In conclusion, increased surveillance and more secure methods of taping of endotracheal tubes are crucial for preventing life-threatening accidental extubations during respiratory support.

Unplanned Extubation in the Neonatal ICU: A Systematic Review, Critical Appraisal, and Evidence-Based Recommendations

“…Brown 11 found that UE rate was higher in neonates Ͻ 1,500 g than in neonates Ͼ 1,500 g (42% vs 23%, P Ͻ .04). Likewise, Horimoto et al 14 found a higher UE rate in infants Ͻ 2,500 g (87%). On the other hand, 3 studies 1,12,17 showed no difference in weight between UE infants and controls.…”

“…Fifteen of these studies met the inclusion criteria. 1,3,5,[9][10][11][12][13][14][15][16][17][18][19][20] Of the 15 studies reviewed, 11 were prospective cohort studies. 3,[10][11][12][13][15][16][17][18][19][20] 3 were retrospective cohort studies, 1,9,14 and 1 was a retrospective and prospective cohort study.…”

“…Two studies 12,14 reported hemodynamic complications immediately after UE. In relation to the total of patients who experienced UEs, the frequencies of bradycardia were 39% 12 and 46%, 14 respectively, and the percentage of neonates requiring cardiopulmonary resuscitation were 5% 12 and 13% 14 in these studies.…”

Reducing Unplanned Extubations in the NICU

“…1,2,5,7,8 Compared with data from PICUs, unplanned extubations in neonatal patients occur 2 to 3 times more frequently. 9 Potential reasons for this increased incidence include longer duration of intubation, shorter length of the trachea in neonates compared with older children, the use of uncuffed endotracheal tubes in neonates, and less routine use of sedation and muscle relaxation, as well as time spent out of bed while being held by parents. Factors that contribute to unplanned extubations include method of fixation of endotracheal tubes; procedures such as weighing and suctioning; and agitation of the patient, resulting in rapid movement of the head.…”

Effect of Anatomical and Developmental Factors on the Risk of Unplanned Extubation in Critically Ill Newborns

“…UEs result in high rates of bradycardia, hypoxemia, chest compressions, 1 and reintubation. 2,3 Further, intubation associated adverse events are more common when intubation courses follow an UE than during intubations for other indications.…”