OBJECTIVE

To assess if neonatologists detect and count unplanned extubations (UEs) uniformly.

STUDY DESIGN

An Institutional Review Board-exempted anonymous web-based survey of neonatology attending and fellow members of the AAP Neonatal-Perinatal Medicine section was administered. Respondents were queried on practices concerning UE; they were then presented with different case scenarios and asked if they would count the event as a UE.

RESULTS

Of the 509 respondents, 61% track UE rates. Of those who track UE rates, 53% reported rates of 1-3 per 100 ventilator days. The top two factors perceived as causing UEs were endotracheal tube (ETT) dislodgement by patient (65%) and failure of ETT holding system at attachment to the face (56%). In the various scenarios where ETT was urgently removed by staff, only 19 to 62% of respondents counted the event as a UE, including 23% if the ETT was removed by the attending. There was consensus on the scenarios representing self-extubation and elective change of the ETT.

CONCLUSIONS

There is wide variation in methods for detecting and counting UE events among neonatologists, which precludes comparison of UE rates across institutions. We speculate that a standardized definition and classification of events will enable benchmarking among neonatal intensive care units, which should accelerate collaborative improvement efforts towards reducing UEs in neonates.