持续质量改进：降低儿科重症监护病房的非计划性拔管率

Continuous quality improvement: reducing unplanned extubations in a pediatric intensive care unit.

作者信息

Sadowski Roxanne, Dechert Ronald E, Bandy Kenneth P, Juno Julie, Bhatt-Mehta Varsha, Custer Joseph R, Moler Frank W, Bratton Susan L

机构信息

Department of Critical Care Support Services, University of Michigan Health System, 200 East Hospital Dr, F5815 Box 0208, Ann Arbor, MI 48109, USA.

出版信息

Pediatrics. 2004 Sep;114(3):628-32. doi: 10.1542/peds.2003-0735-L.

DOI:10.1542/peds.2003-0735-L

PMID:15342831

Abstract

OBJECTIVE

Unplanned extubation (UEX) is a potentially serious complication of mechanical ventilation. Limited information is available regarding factors that contribute to UEXs and subsequent reintubation of children. We monitored UEXs in our pediatric intensive care unit (PICU) for a 5-year period to assess the incidence and patient conditions associated with UEX and to evaluate whether targeted interventions were associated with a reduced rate of UEXs.

METHODS

Over a 5-year period, demographic and clinical information was collected prospectively on all patients who required an artificial airway while admitted to the PICU. Additional information was collected for patients who experienced an UEX. Educational sessions and care management protocols were developed, implemented, and modified according to issues identified via the monitoring program.

RESULTS

From a total of 2192 patients who required 13 630 airway days (AWD), 141 (6%) patients experienced 164 UEXs. The overall rate of UEX for the study period was 1.2 UEXs per 100 AWD, and this rate decreased from 1.5 in the first year to 0.8 in the last year. UEXs were more common in children who were younger than 5 years (1.6 vs 0.6 UEX per 100 AWD) compared with older children. The UEX children experienced significantly longer length of mechanical ventilation (6 vs 3 days) and longer length of PICU stay (8 vs 4 days) compared with non-UEX children. Forty-six percent of the UEXs occurred in patients who were weaning from mechanical ventilation, and 22% of those patients required reintubation.

CONCLUSIONS

We conclude that UEX in pediatric patients is associated with longer length of mechanical ventilation and length of stay in the PICU. A continuous quality improvement monitoring and educational program that identified high-risk patients for UEX (younger patients) and patients who were at low risk for subsequent reintubation (weaning patients) contributed to a reduction of these potentially adverse events.

摘要

目的

非计划拔管（UEX）是机械通气潜在的严重并发症。关于导致儿童UEX及随后再次插管的因素，现有信息有限。我们对儿科重症监护病房（PICU）5年间的UEX情况进行了监测，以评估与UEX相关的发生率和患者状况，并评估针对性干预措施是否与UEX发生率降低相关。

方法

在5年期间，前瞻性收集了所有入住PICU时需要人工气道的患者的人口统计学和临床信息。对于发生UEX的患者收集了额外信息。根据监测计划发现的问题制定、实施并修改了教育课程和护理管理方案。

结果

在总共2192例需要13630个气道日（AWD）的患者中，141例（6%）患者发生了164次UEX。研究期间UEX的总体发生率为每100个AWD有1.2次UEX，该发生率从第一年的1.5降至最后一年的0.8。与大龄儿童相比，5岁以下儿童的UEX更为常见（每100个AWD分别为1.6次和0.6次UEX）。与未发生UEX的儿童相比，发生UEX的儿童机械通气时间显著更长（6天对3天），PICU住院时间更长（8天对4天）。46%的UEX发生在正在撤机的患者中，其中22%的患者需要再次插管。