Unplanned Extubation in the Neonatal ICU: A Systematic Review, Critical Appraisal, and Evidence-Based Recommendations

Silva, Paulo Sérgio Lucas da; Reis, Maria Eunice; Aguiar, Vânia Euzébio de; Fonseca, Marcelo Cunio Machado

doi:10.4187/respcare.02164

Cited by 85 publications

(131 citation statements)

References 23 publications

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“…15 Although it may seem intuitive that restraining patients might prevent self-extubations, the rate of patients in restraints at the time of unplanned extubation is roughly 60%. 10,15,16,20 This suggests that restraints do not prevent self-extubation. Moreover, they can contribute to agitation, 10 and are discouraged unless necessary due to other safety concerns.…”

Section: Unplanned Extubationsmentioning

confidence: 99%

“…7,11,13 Approximately 50% of these patients will require re-intubation (range of 10 -78%). [6][7][8]11,13,15,16 Based upon the literature, successful strategies for the prevention of unplanned extubations include standardized protocols for securing the tracheal tube, 15,[17][18][19][20] titration of sedation, [15][16][17]21 weaning patients off mechanical ventilation, 16,20 tube suctioning, patient hygiene, and transport. 15 Although it may seem intuitive that restraining patients might prevent self-extubations, the rate of patients in restraints at the time of unplanned extubation is roughly 60%.…”

Section: Unplanned Extubationsmentioning

confidence: 99%

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Ventilator-Related Adverse Events: A Taxonomy and Findings From 3 Incident Reporting Systems

et al. 2016

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. Once each organization had its dataset of ventilator-related adverse events, reviewers read the narrative descriptions of each event and classified it according to the developed common taxonomy. RESULTS: A Pennsylvania Patient Safety Authority, FDA, and UHC search provided 252, 274, and 700 relevant reports, respectively. The 3 event types most commonly reported to the UHC and the Pennsylvania Patient Safety Authority's Patient Safety Reporting System databases were airway/breathing circuit issue, human factor issues, and ventilator malfunction events. The top 3 event types reported to the FDA were ventilator malfunction, power source issue, and alarm failure. CONCLUSIONS: Overall, we found that (1) through the development of a common taxonomy, adverse events from 3 reporting systems can be evaluated, (2) the types of events reported in each database were related to the purpose of the database and the source of the reports, resulting in significant differences in reported event categories across the 3 systems, and (3) a public-private collaboration for investigating ventilator-related adverse events under the P5S model is feasible.

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Section: Unplanned Extubationsmentioning

confidence: 99%

Section: Unplanned Extubationsmentioning

confidence: 99%

Ventilator-Related Adverse Events: A Taxonomy and Findings From 3 Incident Reporting Systems

et al. 2016

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“…Risk factors included age \2 years, agitation, increased saliva, increased duration of ventilation Silva et al [10] Systematic review 2013 Neonates 0.14-5.3 per 100 intubation days Lucas da Silva et al [11] Systematic review 2010 Pediatric 0.11-2.27 per 100 intubation days Piva et al [12] Prospective observational …”

Section: Referencesmentioning

confidence: 99%

Unplanned extubation: securing the tool of our trade

2015

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“…[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. 1,2,5,7,8 Compared with data from PICUs, unplanned extubations in neonatal patients occur 2 to 3 times more frequently.…”

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.…”

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confidence: 99%

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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Unplanned Extubation in the Neonatal ICU: A Systematic Review, Critical Appraisal, and Evidence-Based Recommendations

Cited by 85 publications

References 23 publications

Ventilator-Related Adverse Events: A Taxonomy and Findings From 3 Incident Reporting Systems

Ventilator-Related Adverse Events: A Taxonomy and Findings From 3 Incident Reporting Systems

Unplanned extubation: securing the tool of our trade

Reducing Unplanned Extubations in the NICU

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