Incidence, outcomes and outcome prediction of unplanned extubation in critically ill children: An 11year experience

R Al-Abdwani; C B Williams; C Dunn; J Macartney; K Wollny; H Frndova; N Chin; D Stephens; C S Parshuram

doi:10.1016/j.jcrc.2017.12.017

Incidence, outcomes and outcome prediction of unplanned extubation in critically ill children: An 11year experience

J Crit Care. 2018 Apr:44:368-375. doi: 10.1016/j.jcrc.2017.12.017. Epub 2017 Dec 24.

Authors

R Al-Abdwani¹, C B Williams¹, C Dunn², J Macartney², K Wollny², H Frndova³, N Chin⁴, D Stephens⁵, C S Parshuram⁶

Affiliations

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.

PMID: 29289914
DOI: 10.1016/j.jcrc.2017.12.017

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.

MeSH terms

Airway Extubation* / methods
Airway Extubation* / statistics & numerical data
Child
Child, Preschool
Critical Illness / therapy*
Device Removal
Female
Guideline Adherence
Humans
Incidence
Infant
Intensive Care Units, Pediatric*
Male
Prognosis
Retrospective Studies