2004 OPEN FORUM Abstracts
ANALYSIS OF UNPLANNED EXTUBATIONS IN A CHILDREN’S HOSPITAL
Betit RRT, John Thompson RRT, John Arnold MD Children’s
Hospital and Harvard Medical School, Boston, MA
Background: Unplanned extubations are a common hazard associated with mechanical ventilation. Unplanned extubations / 100 days of ventilation have been reported at 0.14 - 8.12 and 0.11 - 7.34 for neonatal and pediatric ICUs respectively. We report the analysis of UEs monitored prospectively over a 5-year period in a children’s hospital with 22 neonatal and 42 pediatric ICU beds.
Methods: A ventilator complication report was completed by RTs at the end of each shift. Ventilator days, unplanned extubations (UE), unplanned extubations / 100 days of ventilation (UE/100), and reintubations (RI) were recorded and evaluated over 5 years from 10/99 to 09/03. A uniform ETT securing procedure, executed only by RTs, was used in all patients during this period.
Results: There were 55,122 ventilator days and 577 UEs in 433 patients. Of the 577 UEs, 330 (57%) occurred in neonatal patients, and 247 (43%) in pediatric. The UE/100 was 1.05 ± 0.29 for both groups combined. The UE/100 for neonatal patients was 2.54 ± 0.77, and 0.60 ± 0.16 for pediatric. RI was required in 227 (39%) of UE cases: 166 (73%) neonatal and 61 (27%) pediatric.
Conclusions:UEs were higher in our neonatal population (patients < 2 weeks of age), which is mainly comprised of pre-term infants. We consider this group to be more prone to UEs than pediatric patients due to the relatively short distance between the thoracic inlet and carina. We have periodically evaluated ETT fixation devices designed for neonates but have not found them to reduce UEs. We attribute the downward trend of UEs in our NICU to heightened awareness, and a periodic review of ETT securing procedures. The UEs in pediatric patients has remained stable. UEs in both populations fall within rates reported in the literature, however, inter-hospital comparisons of UEs to institutions with similar demographics may be a better means of determining acceptable UE rates. We consider the RI rate to be low which may indicate a delayed decision to extubate, particularly in the pediatric group. The evaluation of UEs is a part of our ongoing ventilator complication QI program. Data from this program are evaluated biannually and guide educational efforts and procedure modifications.