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

Abstract

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 () 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 () and the rate () 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.