Effectiveness of a bundle to prevent unplanned extubation in a pediatric intensive care unit: A multidisciplinary approach

Abstract

Endotracheal intubation is one of the most common invasive procedures in routine pediatric intensive care. Unplanned extubation occurs when an endotracheal tube is inadvertently removed. To observe and report the incidence of unplanned extubation in children before and after the introduction of a series of measures aimed at controlling and reducing this adverse event in a pediatric intensive care unit. In 2016, a total of 312 patients were hospitalized in the pediatric intensive care unit. Of these, 120 received mechanical ventilation and there were 30 unplanned extubations, corresponding to an annual incidence of 4.24%. In 2017, the corresponding figures were 301, 163, 42 and 3.4%. In 2018, after the introduction of measures to control and reduce the number of unplanned extubations, the corresponding figures were 335, 195, 31 and 1.79%. The incidence in 2018 was statistically significantly lower than in 2017 and 2016 (p < 0.01). Systematic control of the incidence of unplanned extubation and the introduction of a bundle of measures led to a significant reduction in this type of extubation in the pediatric intensive care unit.