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Achieving Sustainability in Reducing Unplanned Extubations in a Pediatric Cardiac ICU.
Censoplano, Nina M; Barrett, Cindy S; Ing, Richard J; Reichert, Kelly; Rannie, Michael; Kaufman, Jon.
Afiliação
  • Censoplano NM; Division of Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Center, Children's Hospital Colorado, Aurora, CO.
  • Barrett CS; Division of Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Center, Children's Hospital Colorado, Aurora, CO.
  • Ing RJ; Division of Anesthesia, Department of Pediatrics, University of Colorado Anschutz Medical Center, Children's Hospital Colorado, Aurora, CO.
  • Reichert K; Department of Nursing, Children's Hospital Colorado, Aurora, CO.
  • Rannie M; Analytics Resource Center, Department of Pediatrics, University of Colorado Anschutz Medical Center, Children's Hospital Colorado, Aurora, CO.
  • Kaufman J; Division of Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Center, Children's Hospital Colorado, Aurora, CO.
Pediatr Crit Care Med ; 21(4): 350-356, 2020 04.
Article em En | MEDLINE | ID: mdl-31688673
OBJECTIVES: To determine the incidence of unplanned extubations in a pediatric cardiac ICU in order to prove sustainability of our previously implemented quality improvement initiative. Additionally, we sought to identify risk factors associated with unplanned extubations as well as review the overall outcome of this patient population. DESIGN: Retrospective chart review. SETTING: Pediatric cardiac ICU at Children's Hospital of Colorado on the Anschutz Medical Center of the University of Colorado. PATIENTS: Intubated and mechanically ventilated patients in the cardiac ICU from July 2011 to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 2,612 hospitalizations for 2,067 patients were supported with mechanical ventilation. Forty-five patients had 49 episodes of unplanned extubations (four patients > 1 unplanned extubation). The average unplanned extubation rate per 100 ventilator days was 0.4. Patients who had an unplanned extubation were younger (0.09 vs 5.45 mo; p < 0.001), weighed less (unplanned extubation median weight of 3.0 kg [interquartile range, 2.5-4.5 kg] vs control median weight of 6.0 kg [interquartile range, 3.5-13.9 kg]) (p < 0.001), and had a longer length of mechanical ventilation (8 vs 2 d; p < 0.001). Patients who had an unplanned extubation were more likely to require cardiopulmonary resuscitation during their hospital stay (54% vs 18%; p < 0.001) and had a higher likelihood of in-hospital mortality (15% vs 7%; p = 0.001). There was a significant difference in surgical acuity as denoted by The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score and patients with an unplanned extubation had a higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category (p = 0.019). Contributing factors associated with unplanned extubation were poor endotracheal tube tape integrity, inadequate tube securement, and/or inadequate sedation. A low rate of unplanned extubation was maintained even in the setting of increasing patient complexity and an increase in patient volume. CONCLUSIONS: A low rate of unplanned extubation is sustainable even in the setting of increased patient volume and acuity. Additionally, early identification of patients at higher risk of unplanned extubation may also contribute to decreasing the incidence of unplanned extubation.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Unidades de Terapia Intensiva Pediátrica / Extubação Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Humans País/Região como assunto: America do norte Idioma: En Revista: Pediatr Crit Care Med Assunto da revista: PEDIATRIA / TERAPIA INTENSIVA Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Unidades de Terapia Intensiva Pediátrica / Extubação Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Humans País/Região como assunto: America do norte Idioma: En Revista: Pediatr Crit Care Med Assunto da revista: PEDIATRIA / TERAPIA INTENSIVA Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos