Reducing unplanned extubation in tertiary NICU: a quality improvement project

Rashida Javed, Kanwal Mahadev, Harsha Gowda
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Abstract

Mechanically ventilated neonates are prone to unplanned extubation (UE) or accidental extubation causing cardiorespiratory deterioration, hypoxia and need for resuscitation.1 Repeated reintubation may result in airway trauma, subglottic stenosis, prolonged ventilation, prolonged hospital stay and increased risk of infection.2 Studies have shown a variation in the rate of UE in neonatal intensive care unit (NICU) from 1.14 to 5.3 per 100 ventilation days.3 Reasons for the increased incidence of UE in neonates include longer duration of intubation, shorter neonatal tracheal length, less routine use of sedation, procedures such as suctioning, the use of uncuffed endotracheal tubes and the method of fixation due to fragile skin.4 Bedside activities such as weighing, kangaroo care, procedures like line placements, scans/imaging, phlebotomy and transportation of babies are potential risk factors for UE.3 5 UE is not uncommon in the NICU but we noticed multiple UEs in our NICU leading to re-intubations. This could have serious side effects like cardiorespiratory deterioration and airway trauma. The aim of this quality improvement project (QIP) is to reduce the rate of UEs among intubated infants in a tertiary NICU over a period of 24 months. ### Making a case for change We engaged local stakeholders (clinicians, nurses, governance team, risk assessment team, X-ray technicians and education team) to evaluate risk factors for …
减少三级新生儿重症监护室的意外拔管:质量改进项目
机械通气的新生儿容易发生计划外拔管(UE)或意外拔管,导致心肺功能恶化、缺氧和需要复苏。1 反复再次插管可能导致气道创伤、声门下狭窄、通气时间延长、住院时间延长和感染风险增加。新生儿 UE 发生率增加的原因包括插管时间较长、新生儿气管长度较短、镇静剂的常规使用较少、吸痰等程序、使用无绷带气管导管以及因皮肤脆弱而使用的固定方法。称重、袋鼠式护理等床边活动以及放置管路、扫描/成像、抽血和运送婴儿等程序都是导致 UE 的潜在风险因素。这可能会产生严重的副作用,如心肺功能恶化和气道创伤。本质量改进项目(QIP)的目标是在 24 个月内降低三级 NICU 插管婴儿的 UE 发生率。### 提出改变的理由 我们让当地的利益相关者(临床医生、护士、管理团队、风险评估团队、X 光技术人员和教育团队)参与进来,以评估发生 UE 的风险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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