An Airway Risk Assessment Score for Unplanned Extubation in Intensive Care Pediatric Patients*

Vats, Atul; Hopkins, Clara; Hatfield, Kelly M; Jia, Yan; Palmér, Robert; Keskinocak, Pınar

doi:10.1097/pcc.0000000000001189

Cited by 13 publications

(9 citation statements)

References 12 publications

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“…Airway risk-assessment scoring systems developed for pediatric ICU patients have been shown to correlate with UE rates and may be a useful method to reduce adverse events associated with UE in the NICU. 23 Our study has several limitations. Data on UE were documented prospectively, but demographic data and data on certain outcomes were obtained retrospectively, so we are unable to correct for any inaccuracies of documentation.…”

Section: Discussionmentioning

confidence: 91%

The Adverse Impact of Unplanned Extubation in a Cohort of Critically Ill Neonates

et al. 2019

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BACKGROUND: We sought to describe adverse events associated with unplanned extubation (UE) and to explore risk factors for serious adverse events post-UE among infants who experienced UE. METHODS: Data were prospectively collected on all infants who had a UE event at a single institution over a 4-y period. Demographic information and information on outcomes were obtained retrospectively. We described the frequency of post-UE adverse events: success or failure of extubation trial if offered, rate of re-intubation, post-UE changes in ventilator settings, and serious adverse events post-UE (eg, need for cardiopulmonary resuscitation, clinical sepsis, and death or tracheostomy prior to discharge). We used a multivariate logistic regression model to identify the risk factors associated with serious adverse events. RESULTS: There were 134 documented UE events. Agitation was the most common known cause. After UE, 49% of the subjects were given a trial of extubation, and 65% of the trials were successful at 48 h. Cardiopulmonary resuscitation (CPR) was performed in 13% of cases. In subjects requiring immediate re-intubation, mean airway pressure (P aw) and oxygen requirement increased in 33% and 55% of the subjects, respectively. Post-UE clinical sepsis occurred in 17% of subjects. Higher pre-UE P aw and difficult re-intubation were associated with a need for CPR. Subjects who received CPR had increased odds (3.7؋) of developing clinical sepsis. CONCLUSION: UE can result in serious adverse events, including hemodynamic instability and possibly an increased risk for clinical sepsis. Difficult re-intubation was associated with a higher risk of needing CPR and, later, tracheostomy and death.

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Section: Discussionmentioning

confidence: 91%

The Adverse Impact of Unplanned Extubation in a Cohort of Critically Ill Neonates

et al. 2019

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“…To date, much research has focused on prolapse in children with longterm intubation with a tracheal tube at NICU. Several studies have reported that 3.39-5.3% of children had unplanned extubation [16,17], and 0.59-0.61% unplanned extubating events/100 intubation days. This evidence suggested that the high-risk factors for unplanned extubation were similar to those of intraoperative prolapse, when tracheal tube was improperly fixed with incomplete patient sedation or lack of operational expertise.…”

Section: Discussionmentioning

confidence: 99%

Impact of changes in head position during head and neck surgery on the depth of tracheal tube intubation in anesthetized children

Yan

Zhang

2020

BMC Anesthesiol

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Background: The classic formula has been used to estimate the depth of tracheal tube intubation in children for decades. However, it is unclear whether this formula is applicable when the head and neck position changes intraoperatively. Methods: We prospectively reviewed the data of 172 well-developed children aged 2-12 years (64.0% boys) who underwent head and neck surgery under general anesthesia. The distances from the tracheal carina to the endotracheal tube tip (CT), from the superior margin of the endotracheal tube tip to the vocal cord posterior commissure (CV), and from the tracheal carina to the posterior vocal commissure (TV) were measured in the sniffing position (maximum), neutral head, and maximal head flexion positions. Results: Average CT and CV in the neutral head position were 4.33 cm and 10.4 cm, respectively. They increased to 5.43 cm and 11.3 cm, respectively, in the sniffing position, and to 3.39 cm and 9.59 cm, respectively, in the maximal flexion position (all P-values < 0.001). TV remained unchanged and was only dependent on age. After stratifying patients by age, similar results were observed with other distances. CT and CV increased by 1.099 cm and 0.909 cm, respectively, when head position changed from neutral head to sniffing position, and decreased by 0.947 cm and 0.838 cm, respectively, when head position changed from neutral head to maximal flexion. Conclusion: Change in head position can influence the depth of tracheal tube intubation. Therefore, the estimated depth should be corrected according to the surgical head position.

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“…Vats et al created an airway risk assessment scoring tool that can stratify pediatric patients and identify patients at risk for unplanned intubation. 50 This tool assigns points for several risk factors, with a score of 5 or higher indicating high risk for UE. The study found a high correlation between the scoring tool and the incidence of unplanned extubation.…”

Section: Increased Awareness Of Risk Factorsmentioning

confidence: 99%

Unplanned Extubation

Berkow

Kanowitz²

2020

PatientSaf

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Endotracheal intubation and extubation are procedures routinely performed by clinicians who manage the airway of critically ill or injured patients (e.g., emergency physicians, anesthesiologists, and intensive care physicians) and patients undergoing general anesthesia (i.e., anesthesiologists and other anesthesia providers). Most of the time, extubation is a planned, intentional, and controlled event and in these circumstances the rate of complications related to extubation has been reported in the literature to be as high as 12%. The unplanned, unintentional, and uncontrolled removal of the endotracheal tube (ETT) can be either due to actions of the patient removing their own tube, defined as self-extubation, or due to an external force applied to the ETT during nursing care or movement of the patient that causes the dislodgement of the tube, defined as accidental extubation. Unplanned extubation is associated with significant complications, including aspiration pneumonia, hypoxemia, arrhythmias, vocal cord injury, brain damage, and death.

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An Airway Risk Assessment Score for Unplanned Extubation in Intensive Care Pediatric Patients*

Abstract: Higher Risk Assessment Scores are associated with occurrence rates of unplanned extubation.

Cited by 13 publications

References 12 publications

The Adverse Impact of Unplanned Extubation in a Cohort of Critically Ill Neonates

The Adverse Impact of Unplanned Extubation in a Cohort of Critically Ill Neonates

Impact of changes in head position during head and neck surgery on the depth of tracheal tube intubation in anesthetized children

Unplanned Extubation

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