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

• Main Authors: Bonnie R. Rachman (Author), Robin Watson (Author), Norline Woods (Author), Richard B. Mink (Author)
• Format: Book
• Published: Hindawi Limited, 2009-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1687-9740; 1687-9759; 10.1155/2009/820495
• Keywords: Pediatrics; RJ1-570
• Source: International Journal of Pediatrics, Vol 2009 (2009)

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 (>.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 (=.03) and the rate (=.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.