Frank B S, Lewis R J
Pediatric Intensive Care Unit, Washoe Medical Center, Reno, NV 89510, USA.
Pediatr Pulmonol. 1997 Jun;23(6):424-8. doi: 10.1002/(sici)1099-0496(199706)23:6<424::aid-ppul5>3.0.co;2-i.
Accidental extubation is a potentially serious event for pediatric or neonatal patients with respiratory failure, especially in clinical settings in which personnel capable of performing reintubation may not be readily available. Thus the rate of accidental extubation in small intensive care units that operate without 24-hour in-house physician availability may be an important quality assurance indicator. The objective of this study were to determine the accidental extubation rate at a single small pediatric intensive care unit (PICU) and compare it with published reports. This study was carried out in a six-bed PICU at Washoe Medical Center in Reno, Nevada, with a relatively low level of patient acuity, as measured by PRISM score and the frequency of intubation, and without 24-hour in-house physician availability. All intubated patients admitted during the 5-year period from January 1, 1989 to December 31, 1993 were included. The primary outcome measure was the occurrence of accidental extubation. We observed only two accidental extubations in 1,749 intubated-patient-days (IPD) (0.114 accidental extubations/100 IPD [95% confidence interval 0.014-0.413 accidental extubations/ 100 IPD]). This rate of accidental extubation was compared with data in published reports from neonatal intensive care units (NICUs) and PICUs, which ranged from 0.14 accidental extubations/100 IPD to 4.36 accidental extubations/100 IPD. The dependence of the observed accidental extubation rate on unit size and institutional experience with intubated patients, as measured by the average number of intubated patients, was examined. We found no evidence that the accidental extubation rate is higher in smaller units or units with less institutional experience. Low rates can be achieved in small units with low acuity.
意外拔管对于患有呼吸衰竭的儿科或新生儿患者来说是一个潜在的严重事件，尤其是在可能无法随时获得能够进行重新插管的人员的临床环境中。因此，在没有24小时驻院医生的小型重症监护病房中，意外拔管率可能是一个重要的质量保证指标。本研究的目的是确定单个小型儿科重症监护病房（PICU）的意外拔管率，并将其与已发表的报告进行比较。本研究在内华达州里诺市瓦肖医疗中心的一个六张床位的PICU中进行，该病房患者病情严重程度相对较低，通过PRISM评分和插管频率衡量，且没有24小时驻院医生。纳入了1989年1月1日至1993年12月31日这5年期间收治的所有插管患者。主要结局指标是意外拔管的发生情况。我们在1749个插管患者日（IPD）中仅观察到2次意外拔管（0.114次意外拔管/100个IPD [95%置信区间0.014 - 0.413次意外拔管/100个IPD]）。将该意外拔管率与新生儿重症监护病房（NICU）和PICU已发表报告中的数据进行比较，后者范围为0.14次意外拔管/100个IPD至4.36次意外拔管/100个IPD。通过插管患者的平均数量衡量，研究了观察到的意外拔管率对单位规模和机构插管患者经验的依赖性。我们没有发现证据表明在较小的单位或机构经验较少的单位中意外拔管率更高。在病情严重程度低的小型单位中可以实现低意外拔管率。
