ArcAngel Resources & References
Reduction in Unintended Extubations in a Level IV Neonatal Intensive Care Unit
- UEs in the NICU are further complicated by limited sedation use, uncuffed ETTs, a humidiﬁed environment, a small surface area, and the fragility of an infant’s face.
- UEs are the fourth most common adverse event in the NICU and can lead to airway trauma, intraventricular hemorrhage, and cardiovascular collapse.
- Poor ETT securement material.
- Tape does not hold.
- Tape lifts easily off DuoDerm.
- Inconsistent taping practices.
- Multiple taping methods used.
- No help with taping.
- Subpar taping or securement from outside places.
- Reinforcing tape when retaping required.
Outcomes, Resource Use, and Financial Costs of Unplanned Extubations in Preterm Infants
What this Study Adds:
In a matched cohort of very-low-birth-weight infants, UEs were associated with ∼1-week longer duration of mechanical ventilation, a 10-day increase in length of stay, and $50,000 increased total hospital costs.
- Unplanned extubations (UEs) are the most common adverse event during mechanical ventilation (MV) in the NICU.
- Most infants who were reintubated within 3 days of their primary UE (32 out of 49, 65%) had increased respiratory support after reintubation as evidenced by a higher mean airway pressure or inspired oxygen concentration in the 24 hours after reintubation compared with those values on the day of UE.
- Exposure to 1 UEs was associated with a nearly 1-week increase in the duration of post matching MV, a 10-day increase in LOS, and a nearly $50,000 increase in total hospital costs.
- Children in a PICU who had a UE had an increased ICU and hospital LOS of 5.5 and 6.5 days, respectively, and increased hospital costs of $36,692 compared with age- and diagnosis-matched controls without a UE.
- Reports consistently show that patients who require reintubation after UE drive many of the adverse clinical and ﬁnancial outcomes.
- In addition to prolonged duration of MV, UEs were associated with worsened respiratory outcomes, including supplemental oxygen use at 36 weeks’ PMA and total days of in-hospital supplemental oxygen use.
- Increased risk of bronchopulmonary dysplasia.
- First, the majority of infants (65%) who were reintubated after UE required escalation of their ventilator settings compared with settings immediately before UE, consistent with previous reports. This acute worsening of respiratory status after UE may lead to prolongation of MV to stabilize respiratory status. Second, it is possible that clinicians may delay planned extubation of infants who were recently reintubated after a UE, especially those who required cardiopulmonary resuscitation.
- Modest investments by hospital systems in quality improvement programs to decrease UEs in the NICU may yield signiﬁcant cost savings while improving overall quality of care.