Unplanned Extubation in the Neonatal ICU: A Systematic Review, Critical Appraisal, and Evidence-Based Recommendations

Unplanned Extubation in the Neonatal ICU: A Systematic Review, Critical Appraisal, and Evidence-Based Recommendations

Author Silva, Paulo Sergio Lucas da Google Scholar
Reis, Maria Eunice Google Scholar
Aguiar, Vania Euzebio Google Scholar
Fonseca, Marcelo Cunio Machado Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Hosp & Maternidade Santa Joana
Abstract OBJECTIVE: To update the state of knowledge on unplanned extubations (UEs) in neonatal ICUs. This review focuses on the following topics: incidence, risk factors, reintubation after UE, outcomes, and prevention. METHODS: the MEDLINE, EMBASE, CINAHL, Scielo, Lilacs, and Cochrane databases were searched for relevant publications from January 1, 1950, through January 30, 2012. Fifteen articles were selected for data abstraction. the search strategy included the following key words: unplanned extubation, accidental extubation, self extubation, unintentional extubation, unexpected extubation, inadvertent extubation, unintended extubation, spontaneous extubation, treatment interference, and airway accident. Study quality was assessed using the Newcastle-Ottawa scale. Grades of recommendation were assessed according to the Oxford Centre for Evidence-Based Medicine's levels of evidence system. Studies with Newcastle-Ottawa scale score >= 5 that included appropriate statistical analysis were deemed of high methodological quality. RESULTS: the overall mean Newcastle-Ottawa scale score was 3.5. UE rates ranged from 0.14 to 5.3 UEs/100 intubation days, or 1% to 80.8%. Risk factors included restlessness/agitation (13-89%), poor fixation of endotracheal tube (8.5-31%), tube manipulation at the time of UE (17-30%), and performance of a patient procedure at bedside (27.5-51%). One study showed that every day on mechanical ventilation increased the UE risk 3% (relative risk 1.03, P < .001). the association between birth weight/gestational age and UE is controversial. Reintubation rates ranged from 8.3% to 100%. There is still a gap of information about strategies addressed to reduce the incidence of UE. the best method of endotracheal tube securement remains a controversial issue. CONCLUSIONS: Despite numerous publications on UE, there are few studies assessing preventive strategies for adverse events and there is a lack of randomized clinical trials. Recommendations are proposed based on the current available literature.
Keywords accidental extubation
endotracheal tube
intubation
neonatal ICU
quality improvement
unplanned extubation
Language English
Date 2013-07-01
Published in Respiratory Care. Irving: Daedalus Enterprises Inc, v. 58, n. 7, p. 1237-1245, 2013.
ISSN 0020-1324 (Sherpa/Romeo, impact factor)
Publisher Daedalus Enterprises Inc
Extent 1237-1245
Origin http://dx.doi.org/10.4187/respcare.02164
Access rights Open access Open Access
Type Review
Web of Science ID WOS:000321939500016
URI http://repositorio.unifesp.br/handle/11600/36463

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