The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

COMPARISON OF THREE ENDOTRACHEAL TUBE STABILIZING TECHNIQUES TO DECREASE UNPLANNED EXTUBATIONS IN VENTILATED NEONATES IN A LEVEL III NEONATAL INTENSIVE CARE UNIT.

Shari A. Toomey; Respiratory dept, Carilion Clinic, Roanoke, VA

Background: Unplanned extubations (UEX) are a serious and potentially life-threatening event for a neonate. Unplanned extubations lead to emergent, less-controlled endotracheal re-intubations. Repeated intubations increase the risk of ventilator associated pneumonia, tracheal injury, and may prolong length of stay. Review of data from June 2009 - Jan 2010 for the our Level III Neonatal Intensive Care Unit (NICU) revealed a rate of 3.4 +/- 7.1 UEX /100 ventilator days, with a year to date (YTD) of 4.5/100 ventilator days. This quality improvement study was undertaken to analyze the impact of three endotracheal tube stabilizing techniques to determine which would decrease the rate of UEXs within the NICU. Our goal was a target of 2.5/100 ventilator days. Method: A prospective cohort quality study was designed. Following review of the literature to determine best practice, three endotracheal tube (ETT) stabilization devices were identified for the study: Standardized Taping (a tape-only protocol); NeoBar TM (a weight-based color coded ETT stabilization device); and Portex (R) (an ETT size-based adhesive securement device). All patients requiring intubation from February 2010 to August 2010 were included in the study; each device was trialed for two months. A tracking tool was developed and data collected included: patient data, was protocol followed, circumstances and personnel present for UEX, level of sedation, and was re-intubation required. Each member of the interdisciplinary care-team was educated on use of each device prior to implementation period. Results: Seventy-eight neonates with a total of 703 ventilator days were included in this study. Of these patients, 17 UEX were observed (2.4/100 ventilator days). Thirty-nine patients were included in the standardized taping arm with a UEX rate of 0.9 +/- 0.7 UEX/100; 27 patients in the NeoBar TM arm with a UEX rate of 3.0 +/- 5.0 UEX/100 and 12 patients in the Portex (R) arm with a UEX rate of 1.0 +/- 4.0 UEX/100. Due to increased UEXs the NeoBar TM trial was discontinued early. Conclusion: Standardized taping was the most successful in decreasing the unplanned extubation rate. This method provided the more secure airway stabilization and was adopted within the NICU as standard of care. By the end of the fiscal year 2010, we achieved a rate of 2.4/100 ventilator days, exceeding our target goal of 2.5/100 ventilator days. We continue to evaluate and track UEXs as part of our ongoing quality initiatives.
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