Reducing Unplanned Extubations in a Pediatric Intensive Care Unit : A Systematic Approach

Abstract EN

Objective.

To prospectively determine the rate of unplanned extubations and contributing factors and determine whether a targeted intervention program would be successful in decreasing the rate of unplanned extubations.

Design.

Prospective, observational study.

Setting.

A 10-bed Pediatric Intensive Care Unit (PICU).

Patients.

All intubated pediatric patients during two time periods: September 1, 2000–March 31, 2001 and November 1, 2001–April 30, 2002.

Interventions.

After determining the rate and causes of unplanned extubation, a program was developed consisting of education and a formalized endotracheal tube taping policy.

Data were then collected after implementation of the program.

Measurements and Main Results.

Prior to the implementation of the program, there were 10 (14.7%) unplanned extubations for a rate of 6.4 unplanned extubations per 100 ventilated days.

Of the ten unplanned extubations, reintubation was required in 2 (20%).

Inadequate sedation, poor taping, and improper position of the endotracheal tube were the items most frequently cited as causing an unplanned extubation.

Following the program, there were two (3.4%) unplanned extubations for 1.0 unplanned extubations per 100 ventilated days.

Neither patient required reintubation.

There were no significant differences (P>.05) in age, weight, endotracheal tube size, or duration of intubation in the two time periods.

However, there was a significant decrease in both the number (P=.03) and the rate (P=.04) of unplanned extubations after the implementation of the quality improvement program.

Conclusions.

The rate of unplanned extubation in a PICU can be decreased with a quality improvement program that targets the institution's specific needs.