Unplanned Extubation in the Neonatal ICU: A Systematic Review, Critical Appraisal, and Evidence-Based Recommendations

@article{daSilva2013UnplannedEI,
  title={Unplanned Extubation in the Neonatal ICU: A Systematic Review, Critical Appraisal, and Evidence-Based Recommendations},
  author={Paulo S{\'e}rgio Lucas da Silva and Maria Eunice Reis and V{\^a}nia Euz{\'e}bio de Aguiar and Marcelo Cunio Machado Fonseca},
  journal={Respiratory Care},
  year={2013},
  volume={58},
  pages={1237 - 1245}
}
OBJECTIVE: To update the state of knowledge on unplanned extubations (UEs) in neonatal ICUs. This review focuses on the following topics: incidence, risk factors, reintubation after UE, outcomes, and prevention. METHODS: The MEDLINE, EMBASE, CINAHL, Scielo, Lilacs, and Cochrane databases were searched for relevant publications from January 1, 1950, through January 30, 2012. Fifteen articles were selected for data abstraction. The search strategy included the following key words: “unplanned… Expand
Phased Quality Improvement Interventions in Reducing Unplanned Extubation in the Neonatal ICU
TLDR
Significant reductions in UE rates were achieved by implementing quality improvement interventions, standardizing endotracheal tube fixation, continuous scrutiny of fixation through checks, 2-person technique for providing care, and adverse event reporting were a few of the important interventions. Expand
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TLDR
Quality improvement (QI) efforts to reduce UE should be encouraged as a means to promote patient safety and improve patient outcomes if, through lack of a unified definition of UE, events that carry the potential for harm are not routinely recognized or reported. Expand
The Adverse Impact of Unplanned Extubation in a Cohort of Critically Ill Neonates
TLDR
UE can result in serious adverse events, including hemodynamic instability and possibly an increased risk for clinical sepsis, according to a multivariate logistic regression model. Expand
An Airway Risk Assessment Score for Unplanned Extubation in Intensive Care Pediatric Patients*
TLDR
Higher Risk Assessment Scores are associated with occurrence rates of unplanned extubation in pediatric patients. Expand
Prevalence of unplanned extubation and associated factors in a neonatal intensive care unit
| INTRODUCTION: Endotracheal intubation is a common procedure in Neonatal Intensive Care Unit (NICU) and Unplanned Extubation (UE) is a severe related event, which increases neonatal morbidity.Expand
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TLDR
A significant improvement was achieved in establishing evidence-based prevention of unplanned extubations in the neonatal intensive care unit of Children's Hospital of Fudan University, China and standardizing the procedures represented an important step toward refining the quality improvement process. Expand
Reducing Unplanned Extubations in a Level IV Neonatal Intensive Care Unit: The Elusive Benchmark
TLDR
A quality improvement effort in a level IV NICU achieved a reduction in UE rates to below 1 per 100 intubated days after more than 5 years, with consistency in practices and widespread communication with the staff critical. Expand
Reducing Unplanned Extubations in the NICU Following Implementation of a Standardized Approach
TLDR
The development of standard guidelines to prevent UE and a quality review process to track UE provided important information for education and practice change and significantly improved the UE rate in the NICU through improved teamwork, accountability, and communication. Expand
Assessment of an Unplanned Extubation Bundle to Reduce Unplanned Extubations in Critically Ill Neonates, Infants, and Children.
TLDR
This multicenter quality improvement initiative targeting all intubated neonatal and pediatric patients is associated with a reduction in UEs and morbidity associated with UE events and may be considered standard of care for pediatric hospitals in the future. Expand
Reducing Unplanned Extubations in the NICU Using Lean Methodology
BACKGROUND: Unplanned extubations can lead to iatrogenic injury and have the potential to contribute to serious safety events. We adopted lean methodology to reduce the unplanned extubation rate in aExpand
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