Unplanned Extubation

Background

Unplanned extubation (UE) refers to the accidental removal of an endotracheal tube (ETT) by the patient or staff during medical and nursing care. UE is a significant patient safety concern, especially in preterm and critically ill newborns, and is considered a quality indicator of patient safety in the neonatal intensive care unit (NICU).

Objectives

The primary objective of this study is to describe the incidence of UEx over the last four years. The secondary objective is to identify associated risk factors and complications related to reintubation.

Methods

We conducted a retrospective chart review of all neonates admitted to the Women's Wellness and Research Center (WWRC) NICU for last 4 years who received mechanical ventilation of any type.

Results

We identified 35 cases of UE with an average birth weight (BW) of 1466 +/- 1044 and gestational age (GA) of 29.2 +/- 6.3. The rates of UE ranged from 0.18 to 0.72 per 100 ventilation days. UE was associated with increased activity of the child and followed by 31.4% secondary to handling of patient or the ETT handling by staff. More than half of the patients required positive pressure ventilation. Reintubation was required in 80% of patients, with successful reintubation on the first attempt in 77% of cases. Respiratory escalation was observed in 45% of patients after UE. Compared to GA-matched infants without UE, ELBW infants with UE had higher rates of severe bronchopulmonary dysplasia (BPD) (adjusted Odds ratio 7.9, 95% C.I 2.6-24.0, p<0.001), pneumothorax (aOR 4.7, 95% C.I 1.13-19.3, p=0.03), and any intraventricular hemorrhage (IVH) (aOR 3.8, 95% C.I 1.6-8.9, p=0.002).

Conclusions

UE is a significant patient safety concern in the NICU, particularly in preterm infants and critically ill newborns. The study identified associated risk factors and complications related to reintubation and found that infants with UE had higher rates of severe BPD, pneumothorax, and IVH compared to GA matched infants without UE. The study highlights the need for effective strategies to prevent and manage UE in neonates.