大型儿童医院中计划性拔管失败的结果。
Outcomes of Unplanned Extubations in a Large Children's Hospital.
机构信息
Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Critical Care Center for Evidence and Outcomes, Pediatric Intensive Care Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
出版信息
Respir Care. 2024 Jan 24;69(2):184-190. doi: 10.4187/respcare.10904.
BACKGROUND
Unplanned extubation (UE) is defined as unintentional dislodgement of an endotracheal tube (ETT) from the trachea. UEs can lead to instability, cardiac arrest, and may require emergent tracheal re-intubation. As part of our hospital-wide quality improvement (QI) work, a multidisciplinary committee reviewed all UEs to determine contributing factors and evaluation of clinical outcomes to develop QI interventions aimed to minimize UEs. The objective was to investigate occurrence, contributing factors, and clinical outcomes of UEs in the pediatric ICU (PICU), cardiac ICU (CICU), and neonatal ICU (NICU) in a large academic children's hospital. We hypothesized that these would be substantially different across 3 ICUs.
METHODS
A single-center retrospective review of UEs in the PICU, CICU, and NICU was recorded in a prospective database for the last 5 y. Consensus-based standardized operational definitions were developed to capture contributing factors and adverse events associated with UEs. Data were extracted through electronic medical records by 3 respiratory therapists and local Virtual Pediatric Systems (VPS) database. Consistency of data extraction and classification were evaluated.
RESULTS
From January 2016-December 2021, 408 UEs in 339 subjects were reported: PICU 52 (13%), CICU 31 (7%), and NICU 325 (80%). The median (interquartile range) of age and weight was 2.0 (0-4.0) months and 5.3 (3.0-8.0) kg. Many UE events were not witnessed (54%). Common contributing factors were routine nursing care (no. = 70, 18%), ETT retaping (no. = 62, 16%), and being held (no. = 15, 3.9%). The most common adverse events with UE were desaturation < 80% (33%) and bradycardia (22.8%). Cardiac arrest occurred in 12%. Sixty-seven percent of UEs resulted in re-intubation within 72 h. The proportion of re-intubation across 3 units was significantly different: PICU 62%, CICU 35%, NICU 71%, < .001.
CONCLUSIONS
UEs occurred commonly in a large academic children's hospital. Whereas UE was associated with adverse events, re-intubation rates within 72 h were < 70% and variable across the units.
背景
非计划性拔管（UE）被定义为气管内导管（ETT）意外脱出气管。UE 可导致不稳定、心跳骤停，可能需要紧急重新气管插管。作为医院范围内质量改进（QI）工作的一部分，一个多学科委员会审查了所有 UE，以确定促成因素和临床结果评估，以制定旨在最大限度减少 UE 的 QI 干预措施。目的是调查大型学术儿童医院儿科 ICU（PICU）、心脏 ICU（CICU）和新生儿 ICU（NICU）中 UE 的发生、促成因素和临床结果。我们假设这在 3 个 ICU 之间会有很大的不同。
方法
对过去 5 年在 PICU、CICU 和 NICU 发生的 UE 进行了一项单中心回顾性前瞻性数据库研究。制定了基于共识的标准化操作定义，以捕获与 UE 相关的促成因素和不良事件。数据由 3 名呼吸治疗师和当地 Virtual Pediatric Systems（VPS）数据库通过电子病历提取。评估了数据提取和分类的一致性。
结果
从 2016 年 1 月至 2021 年 12 月，339 名患者中有 408 例 UE 报告：PICU 52 例（13%），CICU 31 例（7%），NICU 325 例（80%）。年龄和体重的中位数（四分位距）为 2.0（0-4.0）个月和 5.3（3.0-8.0）kg。许多 UE 事件未被目击（54%）。常见的促成因素包括常规护理（70 例，18%）、ETT 重新固定（62 例，16%）和被抱（15 例，3.9%）。与 UE 相关的最常见不良事件是饱和度 < 80%（33%）和心动过缓（22.8%）。发生心跳骤停 12%。67%的 UE 在 72 小时内需要重新插管。3 个单位之间的重新插管比例有显著差异：PICU 62%，CICU 35%，NICU 71%，<.001。
结论
大型学术儿童医院 UE 发生率较高。尽管 UE 与不良事件相关，但 72 小时内重新插管率 < 70%，且在各单位之间存在差异。
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