Quality improvement efforts are focused on care processes with the goal of eliminating errors and adverse events. This process begins with the identification of a problem and its causative factors. Then, a plan is implemented to eliminate these factors. The results are analyzed to ascertain selleck inhibitor whether the plan has decreased the identified problem. The use of endotracheal intubation is routine in the care of critically ill children [1]. Extubation is performed when the need for mechanical ventilation has resolved. Unplanned extubation is the displacement or removal of the endotracheal tube at a time other than that specifically chosen for a planned extubation and is a serious adverse event [2�C4]. Previous investigations have shown that the rate of unplanned extubations in infants and children in the PICU ranges from 0.
114 to 4.36 per 100 ventilated days [5, 6]. Generally, 1.0 unplanned extubations per 100 ventilated days are considered within national standards acknowledging that all unplanned extubations are unacceptable [2, 5]. Unplanned extubation exposes the patient to morbidity and mortality over and above those associated with the patient’s underlying disease [6, 7]. Kurachek et al. showed that an unplanned extubation prolongs time of intubation thereby increasing the patient’s exposure to hazards of airway intervention and mechanical ventilation [2]. In their investigation, PICU length of stay more than doubled after an unplanned extubation. It is more common to require reintubation after an unplanned extubation than after a planned extubation [8].
In addition, emergent reintubation may be needed at a time when the patient has not been fasting, posing a risk of aspiration [9]. Moreover, reintubation may be needed when personnel available for the procedure have less experience and skill with emergency airway management in contrast to a reintubation that takes place after a planned extubation where appropriate staff is readily available [2, 10]. In a multicenter study of risk factors and outcomes of extubation failures in the PICU the failure rate after unplanned extubation was 37.5% but only 6.2% after a planned extubation [2]. All unplanned extubations are unacceptable due to their potential for causing unnecessary harm to the patient. Our impression was that there was a high rate of unplanned extubations in our PICU.
As a quality Dacomitinib improvement effort, we prospectively determined the unplanned extubation rate in the PICU as well as the contributing factors. Based on these data, we developed a targeted intervention program hypothesizing that it would be able to decrease unplanned extubations. 2. Methods The Institutional Review Board waived the need for informed consent. The study included all intubated patients in a 10-bed PICU located in a general county teaching hospital.