Little L A, Koenig J C, Newth C J
Department of Pediatrics, Childrens Hospital of Los Angeles, CA 90054-0700.
Crit Care Med. 1990 Feb;18(2):163-5. doi: 10.1097/00003246-199002000-00007.
All patients intubated in the neonatal (NICU) and pediatric (PICU) ICUs over a 3-yr period were evaluated prospectively to determine the incidence of accidental extubation (AE) and contributing factors. Two thousand two hundred patients (age range 26 wk gestation to 18 yr) were intubated for a total of 21,222 days. In the PICU and NICU, a total of 153 patients experienced 195 AE. The PICU had 113 AE in 1,388 subunit for a rate of 1.15 AE/100 intubated days. The NICU had 82 AE in 812 intubated patients, a rate of 0.72 AE/100 intubated days. A review of factors contributing to AE showed the most critical to be: sedation not administered in the 2 h before AE (65%), the lack of two-point or more restraints (58%), and the performance of a patient procedure at the bedside (49%). One death occurred as an indirect consequence of AE. The data are being reported as a function of number of days intubated in an attempt to standardize reporting techniques. The use of standardized reporting and the identification of high-risk factors may be useful for education and modification of patient care practices.
对新生儿重症监护病房（NICU）和儿科重症监护病房（PICU）在3年期间内所有接受气管插管的患者进行前瞻性评估，以确定意外拔管（AE）的发生率及相关因素。2200例患者（年龄范围为妊娠26周龄至18岁）共接受气管插管21222天。在PICU和NICU，共有153例患者发生了195次意外拔管。PICU在1388个亚组中有113次意外拔管，发生率为1.15次意外拔管/100个气管插管日。NICU在812例气管插管患者中有82次意外拔管，发生率为0.72次意外拔管/100个气管插管日。对导致意外拔管的因素进行回顾发现，最为关键的因素是：意外拔管前2小时内未给予镇静（65%）、未使用两点或更多约束措施（58%）以及在床边进行患者操作（49%）。有1例死亡是意外拔管的间接后果。这些数据作为气管插管天数的函数进行报告，旨在使报告技术标准化。使用标准化报告和识别高危因素可能有助于开展教育并改进患者护理实践。
