Reducing unplanned extubation in tertiary NICU: a quality improvement project

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 …