Vats Atul, Hopkins Clara, Hatfield Kelly M, Yan Jia, Palmer Robert, Keskinocak Pinar
1Children's Healthcare of Atlanta, Atlanta, GA. 2Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 3Department of Respiratory Care, Children's Healthcare of Atlanta, Atlanta, GA. 4Georgia Institute of Technology, Atlanta, GA. 5School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA.
Pediatr Crit Care Med. 2017 Jul;18(7):661-666. doi: 10.1097/PCC.0000000000001189.
As a result of a workshop to identify common causes of unplanned extubation, Children's Healthcare of Atlanta developed a scoring tool (Risk Assessment Score) to stratify patients into groups of low, moderate, high, and extreme risk. This tool could be used to institute appropriate monitoring or interventions for patients with high risks of unplanned extubation to enhance safety. The objective of this study is to test the hypothesis that the Risk Assessment Score will correlate with the occurrence rate of unplanned extubation in pediatric patients.
Retrospective review of 2,811 patients at five ICUs conducted between December 2012 and July 2014.
Five ICUs at two freestanding pediatric hospitals within a large children's healthcare system in the United States.
All intubated pediatric patients.
Data of intubations and Risk Assessment Score were collected. Extubation outcomes and severity levels were compared across demographic groups and with the maximum Risk Assessment Score of each intubation.
Out of 4,566 intubations, 244 were unplanned extubations (5.3%). The occurrence rates of unplanned extubations in those less than 1, 1-6, and more than 6 years old were 6.7%, 3.6%, and 2.7%, respectively, corresponding to a rate of 0.59, 0.53, and 0.58 unplanned extubation every 100 ventilator days. The occurrence rates were 13.6% for patients weighing less than 1 kg (0.59 unplanned extubation per 100 ventilation days) and 3.8% for patients weighing greater than or equal to 1 kg (0.58 unplanned extubation per 100 ventilation days). For intubations with maximum risk score falling in risk categories of low, moderate, high, and extreme, the occurrence rates were 4.7%, 7.7%, 12.0%, and 8.3%, respectively, which corresponded to rates of 0.54, 0.62, 0.95, and 0.92 unplanned extubation per 100 ventilator days.
Higher Risk Assessment Scores are associated with occurrence rates of unplanned extubation.
在一次旨在确定非计划拔管常见原因的研讨会上，亚特兰大儿童医疗保健机构开发了一种评分工具（风险评估评分），以将患者分为低、中、高和极高风险组。该工具可用于对有非计划拔管高风险的患者实施适当的监测或干预措施，以提高安全性。本研究的目的是检验风险评估评分与儿科患者非计划拔管发生率相关的假设。
对2012年12月至2014年7月期间在五个重症监护病房的2811例患者进行回顾性研究。
美国一个大型儿童医疗保健系统内两家独立儿科医院的五个重症监护病房。
所有插管的儿科患者。
收集插管和风险评估评分的数据。比较不同人口统计学组的拔管结果和严重程度水平，并与每次插管的最高风险评估评分进行比较。
在4566次插管中，有244次为非计划拔管（5.3%）。1岁以下、1 - 6岁和6岁以上患者的非计划拔管发生率分别为6.7%、3.6%和2.7%，相当于每100个呼吸机日分别有0.59次、0.53次和0.58次非计划拔管。体重小于1kg的患者发生率为13.6%（每100个通气日0.59次非计划拔管），体重≥1kg的患者发生率为3.8%（每100个通气日0.58次非计划拔管）。对于最高风险评分处于低、中、高和极高风险类别的插管，发生率分别为4.7%、7.7%、12.0%和8.3%，相当于每100个呼吸机日分别有0.54次、0.62次、0.95次和0.92次非计划拔管。
较高的风险评估评分与非计划拔管发生率相关。
