Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Sevidor Público Municipal, São Paulo, Brazil.
Respir Care. 2013 Jul;58(7):1237-45. doi: 10.4187/respcare.02164. Epub 2012 Dec 27.
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.
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 extubation," "accidental extubation," "self extubation," "unintentional extubation," "unexpected extubation," "inadvertent extubation," "unintended extubation," "spontaneous extubation," "treatment interference," and "airway accident." Study quality was assessed using the Newcastle-Ottawa scale. Grades of recommendation were assessed according to the Oxford Centre for Evidence-Based Medicine's levels of evidence system. Studies with Newcastle-Ottawa scale score ≥ 5 that included appropriate statistical analysis were deemed of high methodological quality.
The overall mean Newcastle-Ottawa scale score was 3.5. UE rates ranged from 0.14 to 5.3 UEs/100 intubation days, or 1% to 80.8%. Risk factors included restlessness/agitation (13-89%), poor fixation of endotracheal tube (8.5-31%), tube manipulation at the time of UE (17-30%), and performance of a patient procedure at bedside (27.5-51%). One study showed that every day on mechanical ventilation increased the UE risk 3% (relative risk 1.03, P < .001). The association between birth weight/gestational age and UE is controversial. Reintubation rates ranged from 8.3% to 100%. There is still a gap of information about strategies addressed to reduce the incidence of UE. The best method of endotracheal tube securement remains a controversial issue.
Despite numerous publications on UE, there are few studies assessing preventive strategies for adverse events and there is a lack of randomized clinical trials. Recommendations are proposed based on the current available literature.
更新新生儿 ICU 中意外拔管（UE）的知识现状。本综述重点关注以下主题：发生率、危险因素、UE 后重新插管、结局和预防。
从 1950 年 1 月 1 日至 2012 年 1 月 30 日，检索 MEDLINE、EMBASE、CINAHL、Scielo、Lilacs 和 Cochrane 数据库中相关的文献。选择了 15 篇文章进行数据提取。检索策略包括以下关键词：“unplanned extubation”、“accidental extubation”、“self extubation”、“unintentional extubation”、“unexpected extubation”、“inadvertent extubation”、“unintended extubation”、“spontaneous extubation”、“treatment interference”和“airway accident”。使用纽卡斯尔-渥太华量表评估研究质量。根据牛津循证医学中心的证据系统评估推荐等级。纽卡斯尔-渥太华量表评分≥5 分且包含适当的统计分析的研究被认为具有较高的方法学质量。
总体平均纽卡斯尔-渥太华量表评分为 3.5 分。UE 发生率范围为 0.14 至 5.3 例/100 插管日，或 1%至 80.8%。危险因素包括躁动/激越（13%-89%）、气管插管固定不良（8.5%-31%）、UE 时气管导管的操作（17%-30%）和床边进行患者操作（27.5%-51%）。一项研究表明，机械通气每天增加 3%的 UE 风险（相对风险 1.03，P<0.001）。出生体重/胎龄与 UE 的关系存在争议。重新插管率范围为 8.3%至 100%。目前，仍缺乏有关减少 UE 发生率的策略信息。气管插管固定的最佳方法仍是一个有争议的问题。
尽管有大量关于 UE 的出版物，但评估不良事件预防策略的研究很少，也缺乏随机临床试验。根据目前现有的文献提出了建议。
