Department of Pediatrics, Division of Neonatology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio.
James M. Anderson Center for Health Systems Excellence.
Pediatrics. 2022 May 1;149(5). doi: 10.1542/peds.2021-052259.
Unplanned extubation (UE) in pediatric patients can result in significant harm or mortality. In our institution, efforts to reduce UE in the ICU were siloed and learnings were not shared. Our goal was to implement shared initiatives across ICUs in a pediatric institution using quality improvement methodology, with the global aim of reducing serious harm caused by UEs.
The study was conducted as a single-center prospective quality improvement initiative in the pediatric, neonatal, and cardiac ICUs of a large, freestanding academic pediatric hospital. Using the model for improvement and plan-do-study-act cycles, our multidisciplinary team implemented multiple interventions to reduce UEs. The primary measure monitored was the monthly UE rate, defined as the number of UEs per 100 ventilator days, which was tracked over time using statistical control charts.
The overall monthly institutional UE rate was reduced from 1.22 UE per 100 ventilator days to 0.2 UE per 100 ventilator days, representing an 84% improvement in rate and reduction of harm. Sixteen percent to 21% of UEs required additional resources because of a difficult airway, and 10% to 22% of UEs resulted in cardiovascular collapse requiring resuscitation.
Significant harm is associated with UEs in pediatric patients. We implemented a bundle for UE reduction across all ICU populations in a pediatric hospital and significantly reduced the rate of UE within our institution and within each individual unit. Allowing variation for implementation of interventions by unit, although targeting a common goal, contributed to overall success and sustainability.
小儿患者的意外拔管（UE）可导致严重伤害甚至死亡。在我院，减少 ICU 中 UE 的努力是孤立的，经验也未共享。我们的目标是使用质量改进方法在儿科机构的各个 ICU 中实施共享计划，全球目标是减少 UE 造成的严重伤害。
该研究是在一家大型独立儿科医院的儿科、新生儿和心脏 ICU 中进行的单中心前瞻性质量改进计划。我们的多学科团队使用改进模型和计划-执行-研究-行动循环，实施了多项干预措施来减少 UE。主要监测指标是每月 UE 率，定义为每 100 个呼吸机日发生的 UE 数，使用统计控制图随时间进行跟踪。
机构整体每月 UE 率从每 100 个呼吸机日 1.22 个 UE 降至每 100 个呼吸机日 0.2 个 UE，发生率降低了 84%，伤害减少。由于气道困难，16%至 21%的 UE 需要额外资源，10%至 22%的 UE 导致心血管崩溃需要复苏。
小儿患者的 UE 与严重伤害相关。我们在儿科医院的所有 ICU 人群中实施了 UE 减少捆绑计划，并显著降低了机构内和每个单位的 UE 发生率。尽管针对共同目标，但允许单位实施干预措施的差异有助于整体成功和可持续性。
