Two-year study of the prevention of unintentional extubation

Pesiri, Anthony J.

doi:10.1097/00002727-199411000-00006

Cited by 20 publications

(4 citation statements)

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“…Additionally, the need for reestablishing airway access in emergency procedures can traumatize the vulnerable neonatal pharynx and larynx. Whereas the setting of unplanned extubation events (UEE) in adult patients (1–3), and to a lesser extent in children has been investigated, there are only limited data on the characteristics and outcome of UEE in preterm and term newborns in neonatal intensive care units (NICUs). This population might be at both a higher risk for UEE because of difficult fixation of the tiny devices on the small face as well as being prone to a worse outcome from rapid mucosal edema and difficult emergency reintubation.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit

Veldman

Trautschold

Weiß

et al. 2006

Pediatric Anesthesia

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Section: Introductionmentioning

confidence: 99%

Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit

Veldman

Trautschold

Weiß

et al. 2006

Pediatric Anesthesia

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“…Third, we were unable to find data on the frequency of re-intubation or information on morbidity related to self-extubation. In the future, researchers need to fill in these holes in order to clarify if additional interventions not considered in this paper, can further reduce the rate of self-extubation [35]. Another limitation we encountered was the fact that data on self-extubation in the literature is disparate and not reported in a uniform manner.…”

Section: Discussionmentioning

confidence: 99%

Self-Extubation in the Surgical Intensive Care Unit and Restraint Policy Change: A Retrospective Study

Denny¹,

Pantin²,

Denny³

et al. 2014

MEDJ

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Background:Self-extubation is a serious complication of mechanical ventilation. The incidence of self-extubation in a university hospital may be altered by a recent policy change, which requires daily written and face-to-face patient re-evaluations regarding the need for restraints in the intensive care units. There are many concerns and suspicions that this might result in less use of restraints and thereby increase the risk of self-extubation.Methods:The goal of this study was to describe the incidence of self-extubation (SE) over time and report any observed change with the change in restraint policy (RP).Results:The rate of self-extubation during the control year was 1.62% which increased to 2.33% during the initial study period and decreased to 1.30% in the following year. The distant follow-up period eight years after the initial change in restraint policy showed a rate of 1.14%. Apache scores did not differ significantly between the years compared.Conclusion:A new restraint policy, which requires frequent reordering by physicians, has the potential to be associated with increased self-extubation, at least temporarily. Staff education may help reduce this risk. Further research will be useful in clarifying which interventions can most reduce this potentially life-threatening complication.

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“…Extubation of critically ill children who have been maintained on large doses of sedatives is challenging. When they are close to an extubation trial, balancing the need for optimal sedation to prevent accidental extubation due to agitation and a need for optimum respiratory drive and airway reflexes for a successful extubation is crucial (1,2). The weaning of sedation during transition to extubation is often not smooth, thereby delaying the extubation (3).…”

Section: Introductionmentioning

confidence: 99%

Propofol Infusion Is a Feasible Bridge to Extubation in General Pediatric Intensive Care Unit

et al. 2020

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Objective: The current literature on propofol infusion as a bridge to extubation in critically ill children is limited to children with burns and congenital cardiac disease. We hypothesize that propofol infusion is a feasible bridge to extubation in mechanically ventilated, critically ill children.Design: Retrospective chart review.Setting: Pediatric intensive care unit of a tertiary care teaching hospital.Patients: Children < 21 years, admitted to our Pediatric intensive care unit (PICU), requiring mechanical ventilation (MV) for at least 48 h and at least two sedative infusions and who received propofol infusion for 4 to 24 h during anticipated extubation from January 2014 to May 2017. Interventions: None.Measurements and Main Results: We assessed extubation success as primary outcome. We defined extubation success as no re-intubation within 24 h after extubation. We also assessed for occurrence of adverse effects of propofol infusion (1) hemodynamic instability [more than 10% change from pre-propofol baseline heart rate (HR) and mean arterial pressure (MAP) measured 4 h before and during propofol infusion, need for any inotrope and/or fluid bolus] and (2) occurrence of lactic acidosis in absence of any documented sepsis. We compared hemodynamic parameters before and during infusion using Wilcoxon Rank Sum Test (significant p-value ≤ 0.05). We evaluated 35 critically ill, mechanically ventilated children. The median age, weight and duration of MV were 3.8 (IQR: 1.25-10.5) years, 12 (IQR: 6-16.2) kilograms and 111 (IQR: 78-212) h, respectively. Of the 35 patients, 15 (43%) were post-surgical (10 general and 5 cardiac) and the remaining 20 (57%) were non-surgical respiratory failure cases. The median (IQR) propofol infusion dose and duration were 64.7 (53.2-81.1) mcg/kg/min and 7.8 h respectively. Only one patient got re-intubated within 24 h of extubation and was later diagnosed with vascular ring. During propofol infusion, 7/35 (20%) patients exhibited transient drop in MAP > 10% from baseline, but none had lactic acidosis or required an inotrope or fluid bolus.Bhalala et al. Propofol Infusion for Extubation ReadinessConclusions: In critically ill, mechanically ventilated patients, propofol infusion used over a short duration (<12 h) was found to be a feasible bridge to extubation. No patient had significant hypotension or lactic acidosis during the infusion.

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Two-year study of the prevention of unintentional extubation

Cited by 20 publications

References 0 publications

Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit

Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit

Self-Extubation in the Surgical Intensive Care Unit and Restraint Policy Change: A Retrospective Study

Propofol Infusion Is a Feasible Bridge to Extubation in General Pediatric Intensive Care Unit

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