Reporting the incidence of unplanned extubation in the neonatal intensive care unit

Aydon, Laurene; Zimmer, Margo; Sharp, Mary

doi:10.1111/jpc.13850

Cited by 18 publications

(17 citation statements)

References 15 publications

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“…2,9,14,15 Our UE rate and identified causes are consistent with other reports in the literature. 2,7,9,10 In our unit, agitation was a commonly cited explanation for UE, followed closely by UE occurring during retaping and with routine handling. Agitation, as noted by the bedside providers, could be the cause of UE or could be the result of an impending UE, and any association between agitation and UE needs to be interpreted with caution.…”

Section: Discussionmentioning

confidence: 87%

“…6,16,17 Some centers have reported more frequent UE during daytime or at change of shift, but we observed no significant difference in UE rates based on time of day in our unit. 10 Given the association of agitation and UE, we evaluated sedation regimens and found that only half of intubated subjects were receiving No CPR: n ϭ 112 subjects; CPR: n ϭ 17 subjects. Data are expressed as median (interquartile range), n (%), or mean Ϯ SD.…”

Section: Discussionmentioning

confidence: 99%

“…8 There have been numerous studies reporting varied incidence rates of UE, but less is reported on adverse event rates occurring after UE and which infants are at greatest risk for additional serious adverse events. 2,7,9,10 Identification of risk factors for infants who are most likely to suffer life-threatening consequences of UE is an important first step in formulating effective UE-prevention strategies. The aim of this study was to describe the adverse events associated with UE, and among those with UE to assess risk factors for subsequent development of serious adverse events.…”

Section: Introductionmentioning

confidence: 99%

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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: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…A coleta de sangue, por exemplo, é habitualmente realizada em dois, em que o médico é responsável pelo procedimento de coleta e o auxiliar atua na contenção do paciente. A necessidade de pelo menos dois membros da equipe para realização de procedimentos em recém-nascido intubados é apontada por alguns autores e compõe uma das ações dos bundles de segurança no cuidado destes pacientes 9,10 .…”

Section: Discussionunclassified

“…Sua morbidade, entretanto, não está bem estabelecida e os autores ressaltam a heterogeneidade dos estudos conduzidos sobre o assunto e a baixa documentação do evento, o que dificulta a análise e conhecimento de seu real impacto. O que se sabe, de fato, é que medidas simples de segurança possuem grande eficácia na redução da ENP e devem ser implementadas em UTIN para garantir o melhor cuidado para os recém-nascido em VM [9][10][11]23 .…”

Section: Discussionunclassified

Prevalência de extubação não planejada e fatores associados em uma unidade de terapia intensiva neonatal

Mattos¹,

Silva²,

Andreazza³

et al. 2020

Rev Pesq Fisio

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INTRODUÇÃO: Intubação endotraqueal é procedimento comum nas Unidades de Terapia Intensiva Neonatais e tem como evento adverso a extubação não planejada, um incidente grave, associado a morbidade neonatal. OBJETIVO: Verificar a prevalência de extubação não planejada e fatores associados em recém-nascidos submetidos à ventilação mecânica na unidade de terapia intensiva neonatal por condições respiratórias, cardíacas ou por pós-operatório. MATERIAIS E MÉTODOS: Estudo transversal, retrospectivo realizado entre março a dezembro de 2017. Os dados foram coletados da ficha de notificação do serviço e incluíram: sexo, peso no momento do evento, comorbidades do paciente, data e hora de ocorrência, condições associadas e conduta pós-extubação. RESULTADOS: Em 38 recém-nascidos em ventilação mecânica foram registrados 72 eventos, a prevalência da extubação não planejada de 4,6%. Entre os fatores identificados, peso inferior a 1.500g foi observado em 20 recém-nascidos (52,6%) e prematuridade em 25 (65,8%). Em 15 recém-nascidos (39,5%) houve mais de um evento/paciente. Peso inferior a 2.500g esteve associado a um risco 6 vezes maior de recorrência do incidente. As condições associadas aos eventos foram agitação motora do recém-nascido (50%), manuseio da cânula endotraqueal (28,3%) e durante procedimentos de rotina do recém-nascido (21,7%). Reintubação foi necessária em 58 casos (80,5%), sendo imediata em 20 (34,5%). CONCLUSÃO: A agitação motora e o manuseio da cânula endotraqueal, portanto, foram os fatores mais associados aos eventos, a recorrência foi mais frequente em recém-nascido com peso inferior a 2.500g. Medidas de prevenção devem incluir o manejo adequado da agitação motora do recém-nascido e implementação de protocolos de manuseio da cânula endotraqueal.

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Clinical application and evaluation of a new type of tracheal catheter fixation belt

Niu

Liu

et al. 2022

Nursing Open

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Aim To evaluate a new fixation band for tracheal catheter in intensive care unit. Design A cross‐sectional study. Methods A total of 90 patients admitted to the ICU between August 2018–February 2019 were enrolled in the study. Patients were randomly divided into experimental group and control group (N = 45/per each group). 3 M strong adhesive tape and a new tracheal catheter fixation band were applied to patients in two groups, respectively. The fixation effect, incidence of mucosal pressure injury and nursing cost were evaluated. Results Forty‐three patients from the experimental group and 42 patients from the control group participated in this study. Mild, moderate and severe catheter dislocation happened in 2, 0, 0 cases in the experimental group, and 6, 3 and 2 cases in the control group, respectively; the difference was statistically significant. The rates of mucosal pressure injury were 4.7% and 21.4%, which was significantly different, and the experiment group had a lower average daily nursing cost related to tracheal intubation. Conclusions The new tracheal catheter fixation band, which allows for accurate fixation, is simple to operate, may reduce the incidence of mucosal pressure injury, decrease the nursing cost and improve the patients' comfort in clinical practice.

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Reporting the incidence of unplanned extubation in the neonatal intensive care unit

Cited by 18 publications

References 15 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

Prevalência de extubação não planejada e fatores associados em uma unidade de terapia intensiva neonatal

Clinical application and evaluation of a new type of tracheal catheter fixation belt

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