Organizational Risk Factors and Clinical Impacts of Unplanned Extubation in the Neonatal Intensive Care Unit

Blanc, Gabriella Le; Jabbour, Elias; Patel, Sharina; Казанцева, О. Г.; Zeid, Marco; Olivier, François; Shalish, Wissam; Beltempo, Marc

doi:10.1016/j.jpeds.2022.06.012

Cited by 13 publications

(8 citation statements)

References 35 publications

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“…Another essential part of the quality improvement study is to determine the type of intervention needed based on the risk factors. Factors associated with UE in the NICU have been investigated in the published articles [18,19,22]. Patient agitation, poor xation of the ETT, frequent suction, nurses working night shifts and/or overtime and a higher patient-to-nurse ratio were related to an increased number of unplanned extubation events in the NICU [19,22].…”

Section: Discussionmentioning

confidence: 99%

“…Factors associated with UE in the NICU have been investigated in the published articles [18,19,22]. Patient agitation, poor xation of the ETT, frequent suction, nurses working night shifts and/or overtime and a higher patient-to-nurse ratio were related to an increased number of unplanned extubation events in the NICU [19,22]. Recent literature provides various strategies to help reduce UE rates.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors associated with the initial unplanned removal of orogastric tubes in NICU: A Single Center Study in China

Fang

Dai

Liu

et al. 2023

Preprint

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Background: Newborns, in particular, are at higher risk for unplanned removal of orogastric tubes (UROGTs). Because there is a lack of studies identifying the incidence and risk factors for UROGTs in China, we designed this case‒control study to investigate them. Method: This study was conducted in China. A total of 111 neonates who received orogastric tubes between October 2022 and February 2023 were analyzed. Univariate and multivariate logistic models were used for risk factor analyses. Results: The rate of UROGTs was 56.8%, and the incidence was 7.2 per 100 tube days. An increased risk of UROGTs was associated with higher agitation scores (OR=17.82, P=0.001), no oral feeding (OR=0.02, P=0.007), fixation tape loosening (OR=22.75, P=0.027) and tape wetting (OR=12.6, P=0.021). Conclusions: The incidence of UROGTs was found to be significantly higher than that of endotracheal tube extubation. The risk factors were higher agitation scores, no oral feeding, fixation tape loosening and tape wetting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors associated with the initial unplanned removal of orogastric tubes in NICU: A Single Center Study in China

Fang

Dai

Liu

et al. 2023

Preprint

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“…1,11 Similarly, research has demonstrated that staffing ratios also impact other iatrogenic complications including unplanned extubation rates and the rates of nosocomial infection. 12,13 A study by Tubbs-Cooley and colleagues 14 found a significant correlation between nursing workload and missed care in the neonatal intensive care unit. This was also highlighted in a systematic review by Imam et al 15 Missed care included things such as parent education and supporting parent involvement in the care and oral feeding of their infants, items that may affect parental confidence and nursing satisfaction.…”

Section: Contributing Factorsmentioning

confidence: 99%

“…Similarly, research has demonstrated that staffing ratios also impact other iatrogenic complications including unplanned extubation rates and the rates of nosocomial infection 12,13. A study by Tubbs-Cooley and colleagues14 found a significant correlation between nursing workload and missed care in the neonatal intensive care unit.…”

Section: Consequences Of the Nursing Shortagementioning

confidence: 99%

Breaking the Cycle of Nursing Chaos

Bagwell,

Cesario,

Fraser

et al. 2023

Advances in Neonatal Care

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“…Repeated intubations, especially those performed on an emergency basis, increase the risk of laryngeal or tracheal injury and scarring, pulmonary injury from excessive ventilation and ventilator-associated pneumonia 11. Known long-term complications of UE are longer lengths of stay, increased duration of mechanical ventilation (MV) and potential increased respiratory morbidity 1 13–17. Note that this duration is both a cause and a consequence of UE 1 13…”

Section: Introductionmentioning

confidence: 99%

Respiratory outcomes and survival after unplanned extubation in the NICU: a prospective cohort study from the SEPREVEN trial

Yager,

Tauzin,

Durrmeyer

et al. 2024

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo compare reintubation rates after planned extubation and unplanned extubation (UE) in patients in neonatal intensive care units (NICUs), to analyse risk factors for reintubation after UE and to compare outcomes in patients with and without UE.DesignProspective, observational study nested in a randomised controlled trial (SEPREVEN/Study on Epidemiology and PRevention of adverse EVEnts in Neonates). Outcomes were expected to be independent of the intervention tested.Setting12 NICUs in France with a 20-month follow-up, starting November 2015.Patientsn=2280 patients with a NICU stay >2 days, postmenstrual age ≤42 weeks on admission.Interventions/exposureCharacteristics of UE (context, timing, sedative administration in the preceding 6 hours, weaning from ventilation at time of UE) and patients.Main outcome measuresHealthcare professional-reported UE rates, reintubation/timing after extubation, duration of mechanical ventilation, mortality and bronchopulmonary dysplasia (BPD).ResultsThere were 162 episodes of UE (139 patients, median gestational age (IQR) 27.3 (25.6–31.7) weeks). Cumulative reintubation rates within 24 hours and 7 days of UE were, respectively, 50.0% and 57.5%, compared with 5.5% and 12.3% after a planned extubation. Independent risk factors for reintubation within 7 days included absence of weaning at the time of UE (HR, 95% CI) and sedatives in the preceding 6 hours (HR 1.93, 95% CI 1.04 to 3.60). Mortality at discharge did not differ between patients with planned extubation or UE. UE was associated with a higher risk of BPD.ConclusionIn the SEPREVEN trial, reintubation followed UE in 58% of the cases, compared with 12% after planned extubation.Trial registration numberNCT02598609.

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Organizational Risk Factors and Clinical Impacts of Unplanned Extubation in the Neonatal Intensive Care Unit

Cited by 13 publications

References 35 publications

Risk factors associated with the initial unplanned removal of orogastric tubes in NICU: A Single Center Study in China

Risk factors associated with the initial unplanned removal of orogastric tubes in NICU: A Single Center Study in China

Breaking the Cycle of Nursing Chaos

Respiratory outcomes and survival after unplanned extubation in the NICU: a prospective cohort study from the SEPREVEN trial

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