R Al-Abdwani1, C B Williams1, C Dunn2, J Macartney2, K Wollny2, H Frndova3, N Chin4, D Stephens5, C S Parshuram6. 1. Centre for Safety Research, Department of Critical Care Medicine, Hospital for Sick Children, Canada. 2. Critical Care Program, Hospital for Sick Children, Canada. 3. Centre for Safety Research, Critical Care Program, Hospital for Sick Children, Canada. 4. Critical Care Program, Informatics, Hospital for Sick Children, Canada. 5. Child Health and Evaluation Sciences Program, The Research Institute, Hospital for Sick Children, Canada. 6. Department of Critical Care Medicine, Department of Paediatrics, Child Health and Evaluation Sciences Program, The Research Institute, Centre for Safety Research Hospital for Sick Children, Canada; Department of Pediatrics, Interdepartmental Division of Critical Care Medicine, Department of Health Policy Management and Evaluation, University of Toronto, Canada. Electronic address: christopher.parshuram@sickkids.ca.
Abstract
PURPOSE: Unplanned extubation represents loss of control in the ICU, is associated with harm and is used as a measure of quality of care. We evaluated the rates and consequences of unplanned extubation. MATERIALS AND METHODS: Eligible patients were intubated, <18years, and in ICU. Patient, care-related and environmental characteristics were compared in patients who did and did not receive positive pressure ventilation in the 24h after events. Rates are expressed per 100 intubation-days. RESULTS: The 11,310 eligible patient-admissions identified were intubated for 75,519days; 410 (3.39%) patients had 458 unplanned extubation events (0.61 events/100 intubation-days). Annual rates of unplanned extubation reduced from 0.98 in 2004 to 0.37 in 2014. Consequences occurred in 245 (53.5%) events and included cardiac arrest in 9 (2%), bradycardia 52 (11%), and stridor 63 (14%). Positive pressure was provided after 263 (57%) events, and was independently associated with pre-event sedative and muscle relaxant drugs, non-use of restraints, respiratory reason for intubation and recent care by more nurses. CONCLUSION: Unplanned extubation was associated with both significant and no morbidity. Modification of factors including more consistent nurse staffing, restraint use, and increased vigilance in patients with previous events may potentially reduce rates and adverse consequences of unplanned extubation.
PURPOSE: Unplanned extubation represents loss of control in the ICU, is associated with harm and is used as a measure of quality of care. We evaluated the rates and consequences of unplanned extubation. MATERIALS AND METHODS: Eligible patients were intubated, <18years, and in ICU. Patient, care-related and environmental characteristics were compared in patients who did and did not receive positive pressure ventilation in the 24h after events. Rates are expressed per 100 intubation-days. RESULTS: The 11,310 eligible patient-admissions identified were intubated for 75,519days; 410 (3.39%) patients had 458 unplanned extubation events (0.61 events/100 intubation-days). Annual rates of unplanned extubation reduced from 0.98 in 2004 to 0.37 in 2014. Consequences occurred in 245 (53.5%) events and included cardiac arrest in 9 (2%), bradycardia 52 (11%), and stridor 63 (14%). Positive pressure was provided after 263 (57%) events, and was independently associated with pre-event sedative and muscle relaxant drugs, non-use of restraints, respiratory reason for intubation and recent care by more nurses. CONCLUSION: Unplanned extubation was associated with both significant and no morbidity. Modification of factors including more consistent nurse staffing, restraint use, and increased vigilance in patients with previous events may potentially reduce rates and adverse consequences of unplanned extubation.
Authors: Darren Klugman; Kristin Melton; Patrick O'Neal Maynord; Aaron Dawson; Gowri Madhavan; Vicki Lee Montgomery; Mary Nock; Anthony Lee; Anne Lyren Journal: JAMA Pediatr Date: 2020-06-01 Impact factor: 16.193