Reducing Accidental Extubation in Neonates

Loughead, Jeffrey L.; Brennan, Rita Allen; DeJuilio, Patricia; Camposeo, Vito; Jane, Wengert; Cooke, David J.

doi:10.1016/s1553-7250(08)34019-7

Cited by 46 publications

(92 citation statements)

References 11 publications

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“…Long-term complications include subglottic stenosis, increased risk of ventilator-associated pneumonia, and increased number of ventilator days, leading to an increased risk of chronic lung disease. [1][2][3] Our data show that quality improvement efforts require constant vigilance, as a sustainable effect on improvement in any practice is difficult to achieve. The most important factor appears to be changing the culture within the NICU so that all staff members recognize unplanned extubation as a potentially avoidable and preventable event.…”

Section: Discussionmentioning

confidence: 87%

“…Unplanned extubations are one complication that can cause rapid cardiorespiratory deterioration and other adverse effects, such as airway trauma, subglottic stenosis due to repeated intubations, and ventilator-associatedpneumonia. [1][2][3] Unplanned extubations are relatively frequent, representing the fourth most common adverse event in North American NICUs. 4 The incidence of unplanned extubations in the NICU ranges from 1% to 80%, [5][6][7][8] and the rate of unplanned extubations ranges from 0.14 to 6.6 per 100 patient-intubated days.…”

mentioning

confidence: 99%

“…4 The incidence of unplanned extubations in the NICU ranges from 1% to 80%, [5][6][7][8] and the rate of unplanned extubations ranges from 0.14 to 6.6 per 100 patient-intubated days. 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.…”

mentioning

confidence: 99%

“…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. 2,8 Although benchmark data exist for PICUs in terms of unplanned extubations 11 , there are no such national data on unplanned extubations for NICUs. After noting what appeared to be a high incidence of unplanned extubations in our NICU during the last 3 months of 2009, we began the present quality improvement project with the aim of reducing unplanned extubations by developing a bundle of potentially better practices implemented in successive Plan-DoStudy-Act (PDSA) cycles.…”

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confidence: 99%

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Reducing Unplanned Extubations in the NICU

et al. 2014

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BACKGROUND AND OBJECTIVES: Unplanned extubation can be a significant event that places the patient at risk for adverse events. Our goal was to reduce unplanned extubations to <1 unplanned extubation per 100 patient-intubated days. METHODS: All unplanned extubations in the NICU beginning in October 2009 were audited. Data collected included time of day, patient weight, and patient care activity at the time of the event. Bundles of potentially better practices were implemented in sequential Plan-Do-Study-Act cycles. Rates of unplanned extubation (number per patient-intubated day) for each month were analyzed by using control charts, and causes of unplanned extubation were analyzed by using Pareto charts. RESULTS: We found a significant decrease in the unplanned extubation rate after implementation of the first bundle of potentially better practices in May 2010 (2.38 to 0.41 per 100 patient-intubated days). Several more Plan-Do-Study-Act cycles were conducted to sustain this improvement. A persistent reduction in the unplanned extubation rate (0.58 per 100 patient-intubated days) began in February 2013. Causes included dislodgement during care and procedures and variation in the fixation of the endotracheal tube. The majority of events occurred in very low birth weight infants during the daytime shift. CONCLUSIONS: Unplanned extubations in the NICU can be reduced by education of staff and by implementing standard practices of care. Sustainability of any practice change to improve quality is critically dependent on culture change within the NICU. We suggest that the benchmark for unplanned extubation should be a rate <1 per 100 patient-intubated days.

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Section: Discussionmentioning

confidence: 87%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Reducing Unplanned Extubations in the NICU

et al. 2014

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“…Among these are infant agitation, excessive secretions, ETT suctioning, head movement, chest physiotherapy, loose tape, a too short external ETT length (between lip and adaptor), ETT taping, and procedures at the bedside including weighing the baby. [3][4][5] There is no definitive data to recommend nasal vs. oral route of intubation; however, post extubation atelectasis may be more frequent after nasal intubation, especially in very low birth weight infants. 6 In the present study, duration A wide variety of ventilator settings have been utilized to provide SNIPPV.…”

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confidence: 99%

Extubações acidentais - será que os bebês estão tentando nos dizer alguma coisa?

Bhandari

2010

J. Pediatr. (Rio J.)

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Assessment of an Unplanned Extubation Bundle to Reduce Unplanned Extubations in Critically Ill Neonates, Infants, and Children

et al. 2020

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IMPORTANCE Unplanned extubations (UEs) in children contribute to significant morbidity and mortality, with an arbitrary benchmark target of less than 1 UE per 100 ventilator days. However, there have been no multicenter initiatives to reduce these events.OBJECTIVE To determine if a multicenter quality improvement initiative targeting all intubated neonatal and pediatric patients is associated with a reduction in UEs and morbidity associated with UE events. DESIGN, SETTING, AND PARTICIPANTSThis multicenter quality improvement initiative enrolled patients from pediatric, neonatal, and cardiac intensive care units (ICUs) in 43 participating children's hospitals from March 2016 to December 2018. All patients with an endotracheal tube requiring mechanical ventilation were included in the study.INTERVENTIONS Participating hospitals implemented a quality improvement bundle to reduce UEs, which included standardized anatomic reference points and securement methods, protocol for high-risk situations, and multidisciplinary apparent cause analyses. MAIN OUTCOMES AND MEASURESThe main outcome measures for this study included bundle compliance with each factor tested and UE rates on the center level and on the cohort level.RESULTS Among the 43 children's hospitals, the quality improvement initiative was associated with an aggregate 24.1% reduction in UE events, from a baseline rate of 1.135 UEs per 100 ventilator days to 0.862 UEs per 100 ventilator days. Across ICU settings studied, the pediatric ICU and neonatal ICU demonstrated centerline shifts, with an absolute reduction in events of 20.6% (from a baseline rate of 0.729 UEs per 100 ventilator days to 0.579 UEs per 100 ventilator days) and 17.6% (from a baseline rate of 1.555 UEs per 100 ventilator days to 1.282 UEs per 100 ventilator days), respectively. Most UEs required reintubation within 1 hour (mean of 120 of 206 events per month [58.3%]), followed by UEs that did not require reintubation (mean of 78 of 206 events per month [37.9%]) and UEs that resulted in cardiovascular collapse (mean of 8 of 206 events per month [3.9%]). Cardiovascular collapse events represented the most significant consequence of UE studied, and the collaborative reduced these UE events by 36.6%, from a study baseline rate of 0.041 UEs per 100 ventilator days to 0.026 UEs per 100 ventilator days.CONCLUSIONS AND RELEVANCE This multicenter quality improvement initiative was associated with a reduction in UEs across different pediatric populations in diverse settings. A significant reduction in event rate and rate of harm (cardiovascular collapse) was observed, which was sustained over the time course of the intervention. This quality improvement process and UE bundle may be considered standard of care for pediatric hospitals in the future.

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Reducing Accidental Extubation in Neonates

Cited by 46 publications

References 11 publications

Reducing Unplanned Extubations in the NICU

Reducing Unplanned Extubations in the NICU

Extubações acidentais - será que os bebês estão tentando nos dizer alguma coisa?

Assessment of an Unplanned Extubation Bundle to Reduce Unplanned Extubations in Critically Ill Neonates, Infants, and Children

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