Incidence, outcomes and outcome prediction of unplanned extubation in critically ill children: An 11 year experience

Al-Abdwani, Raghad; Williams, Cameron; Dunn, C.L.; Macartney, Jason; Wollny, Krista; Frndova, Helena; Chin, N. M.; Stephens, Dianne P.; Parshuram, Christopher S.

doi:10.1016/j.jcrc.2017.12.017

Cited by 34 publications

(53 citation statements)

References 19 publications

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“…The trend of UE rate showed a decrease fashion in previous 2 long-term studies by Chao et al (15-year period in adult patients, from 0.9 to 0.14 /100 MV days) and by Al-Abdwani et al (11-year period in pediatric patients, from 0.92 to 0.37 /100 MV days). [3,5] The insignificant change of UE trend in our study might be due to the relative short study period. The UEs in our study usually resulted from multiple reasons.…”

Section: Discussionmentioning

confidence: 61%

“…According to the previous literature, the incidence rate of UE ranges from 0.5% to 35.8% and 0.1 to 4.2 events/100 intubation days. [1–5] The immediate complications after UE include laryngeal or vocal cord injury, hypoxemia, respiratory failure, tachyarrhythmia, hypotension, aspiration pneumonia, and even death. [1,4]…”

Section: Introductionmentioning

confidence: 99%

“…The reintubation rate in patients with UE ranges from 1.8% to 88%, and these patients are at a higher risk of difficult intubation and hypoxemia. [1,3,5,6] Mort [7] performed a study on 61 patients who had reintubation within 3 days after UE. In total, 54 (89%) patients required reintubation within 2 hours, and 40 (66%) patients were reintubated within 30 minutes.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of unplanned extubation in ordinary ward are similar to those in intensive care unit

et al. 2019

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Unplanned extubation (UE) may cause considerable adverse effects in patients receiving mechanical ventilation (MV). Previous literature showed inconsistent prognosis in patients with UE. This study aimed to evaluate the clinical implications and outcomes of UE.The intubated adult patients with MV support in our hospital were enrolled, and they were divided into the UE and non-UE groups. Demographic data, admission unit, MV duration, overall weaning rate, and mortality rates were compared. The outcomes of UE in ordinary ward and intensive care unit (ICU) were also assessed.Totally 9245 intubated adult patients were included. UE occurred in 303 (3.5%) patients, and the UE events were 0.27 times/100 MV days. Old age, nonoperation related MV cause, and admission out of the ICU were significant factors associated with UE events. UE patients showed a trend of better overall weaning rate (71.9% vs 66.7%, P = .054) than non-UE. However, the in-hospital mortality rate (25.7% vs 24.8%, P = .713) were similar between the UE and non-UE patients. The reintubation rate of UE patients was 44.1% (142/322). Successful UEs were associated with patients in weaning process (52.8% vs 38.7%, P = .012), and patients received non-invasive positive pressure ventilation (NIPPV) support after UE (19.4% vs 3.5%, P < .001). Patients with successful UE had significantly shorter MV days, higher overall weaning rate, and lower mortality than those with unsuccessful UE. Outcomes of UE in ordinary ward and in ICU had similar MV duration, reintubation rate, overall weaning rate, and in-hospital mortality rate.The overall weaning rate and in-hospital mortality rates of the UE and non-UE patients were similar. UE occurred in ordinary ward had similar outcomes to those in ICU. Patients receiving MV should be assessed daily for weaning indications to reduce delayed extubation, and therefore, may decrease UE occurrence. Once the UE happened, NIPPV support may reduce the reintubation rate.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of unplanned extubation in ordinary ward are similar to those in intensive care unit

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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“…1 It is an important indicator of quality care and patient safety in all patient populations. [2][3][4][5] UE is associated with temperature instability, prolonged mechanical ventilation, hypoxia, hypercarbia, hypocarbia, ventilator-associated pneumonia, longer hospital stay, and mortality. 3,[6][7][8][9][10][11] Repeated intubation as a result of UE puts infants at risk of emergent intubation and risk of injury to the upper airway.…”

Section: Introductionmentioning

confidence: 99%

Phased Quality Improvement Interventions in Reducing Unplanned Extubation in the Neonatal ICU

Nair

Smith

2020

Respir Care

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BACKGROUND: Unplanned extubation (UE) is a common adverse event and is an important measure of quality and patient safety in the neonatal ICU. It is well recognized that UEs occur more frequently in neonates than in any other group of ventilated patients. The objective of this study was to evaluate the effectiveness of the quality improvement interventions in reducing the rates of UE in a tertiary neonatal ICU. METHODS: A retrospective audit performed on ventilated infants showed a rate of 7.2 unplanned extubations per 100 ventilation days in a 12-month period (April 2016 to March 2017). We evaluated the common factors associated with UEs, with the primary reasons being loose fixation and providing care without assistance. We introduced sequential interventions focusing on better practices. Standardizing endotracheal tube fixation, continuous scrutiny of fixation through checks, 2-person technique for providing care, and adverse event reporting were a few of the important interventions. Rates of UE for each month were collected and analyzed. RESULTS: With interventions, UE rates reduced by 80% (from 7.2 per 100 ventilated days in the pre-implementation period to 1.4 per 100 ventilated days in the post-implementation period) in 12-18 months. CONCLUSIONS: Significant reductions in UE rates were achieved by implementing quality improvement interventions. It is important to analyze critical event rates continuously and for longer periods of time to determine the true change.

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Incidence, outcomes and outcome prediction of unplanned extubation in critically ill children: An 11 year experience

Cited by 34 publications

References 19 publications

Outcomes of unplanned extubation in ordinary ward are similar to those in intensive care unit

Outcomes of unplanned extubation in ordinary ward are similar to those in intensive care unit

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

Phased Quality Improvement Interventions in Reducing Unplanned Extubation in the Neonatal ICU

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