Kriti Gupta, Luis Espinosa, Shalini Penikilapate, Sindhaghatta Venkatram, Gilda Diaz-Fuentes
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This study evaluates the impact of PI strategies on UE rates and associated patient outcomes in an adult ICU.</p><p><strong>Objectives: </strong>To determine the impact of performance improvement (PI) strategies on rates of unplanned extubation (UE), reintubation, tracheostomy, mortality, and length of hospital stay in ICU patients.</p><p><strong>Design: </strong>Retrospective cohort studyMethods:This retrospective observational study included 6,397 mechanically ventilated patients admitted to a single tertiary ICU between 2015 and 2023. Three distinct time periods were compared: Period 1 (2015-2017, pre-PI), Period 2 (2018-2020, early-PI), and Period 3 (2021-2023, sustained-PI). Demographics, sedation practices, UE characteristics, and outcomes were analyzed using logistic regression.</p><p><strong>Results: </strong>UE incidence declined significantly from 3.79% in Period 1 to 2.17% in Period 3 (<i>p</i> = 0.002). Reintubation rates dropped from 45.2% to 26.7% (<i>p</i> = 0.011), and tracheostomy rates from 19.0% to 2.2% (<i>p</i> < 0.001). Multivariate analysis showed reduced odds of reintubation in Periods 2 (OR = 0.219, <i>p</i> = 0.001) and 3 (OR = 0.345, <i>p</i> = 0.021) and reduced odds of tracheostomy in Period 3 (OR = 0.011, <i>p</i> = 0.016). Risk factors for reintubation included the absence of prior intubation history and not undergoing spontaneous breathing trials. Older age (⩾71 years) and positive urine toxicology for opiates were strongly associated with tracheostomy.</p><p><strong>Conclusion: </strong>Implementation of PI strategies significantly reduced rates of unplanned extubation, reintubation, and tracheostomy. These findings support continued quality improvement initiatives in ICU airway management.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251383662"},"PeriodicalIF":3.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of performance improvement strategies on unplanned extubation in an inner-city intensive care unit.\",\"authors\":\"Kriti Gupta, Luis Espinosa, Shalini Penikilapate, Sindhaghatta Venkatram, Gilda Diaz-Fuentes\",\"doi\":\"10.1177/17534666251383662\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Unplanned extubation (UE) in intensive care units (ICUs) is a significant patient safety concern, associated with increased morbidity and healthcare utilization; the reported rates of UE vary from 1% to 15%. There is sparse data on the effects of multiple performance improvement (PI) strategies to decrease the rate of UE, particularly in inner-city ICU populations. This study evaluates the impact of PI strategies on UE rates and associated patient outcomes in an adult ICU.</p><p><strong>Objectives: </strong>To determine the impact of performance improvement (PI) strategies on rates of unplanned extubation (UE), reintubation, tracheostomy, mortality, and length of hospital stay in ICU patients.</p><p><strong>Design: </strong>Retrospective cohort studyMethods:This retrospective observational study included 6,397 mechanically ventilated patients admitted to a single tertiary ICU between 2015 and 2023. Three distinct time periods were compared: Period 1 (2015-2017, pre-PI), Period 2 (2018-2020, early-PI), and Period 3 (2021-2023, sustained-PI). Demographics, sedation practices, UE characteristics, and outcomes were analyzed using logistic regression.</p><p><strong>Results: </strong>UE incidence declined significantly from 3.79% in Period 1 to 2.17% in Period 3 (<i>p</i> = 0.002). Reintubation rates dropped from 45.2% to 26.7% (<i>p</i> = 0.011), and tracheostomy rates from 19.0% to 2.2% (<i>p</i> < 0.001). Multivariate analysis showed reduced odds of reintubation in Periods 2 (OR = 0.219, <i>p</i> = 0.001) and 3 (OR = 0.345, <i>p</i> = 0.021) and reduced odds of tracheostomy in Period 3 (OR = 0.011, <i>p</i> = 0.016). Risk factors for reintubation included the absence of prior intubation history and not undergoing spontaneous breathing trials. Older age (⩾71 years) and positive urine toxicology for opiates were strongly associated with tracheostomy.</p><p><strong>Conclusion: </strong>Implementation of PI strategies significantly reduced rates of unplanned extubation, reintubation, and tracheostomy. 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引用次数: 0
摘要
背景:重症监护病房(icu)的计划外拔管(UE)是一个重要的患者安全问题,与发病率和医疗保健利用率的增加有关;报告的UE率从1%到15%不等。关于多种绩效改进(PI)策略对降低UE率的影响的数据很少,特别是在市中心ICU人群中。本研究评估了PI策略对成人ICU患者UE率和相关患者预后的影响。目的:确定绩效改进(PI)策略对ICU患者非计划拔管(UE)、再插管、气管切开术、死亡率和住院时间的影响。设计:回顾性队列研究方法:这项回顾性观察性研究包括2015年至2023年在单一三级ICU住院的6397例机械通气患者。比较了三个不同的时间段:第一阶段(2015-2017年,pi前期),第二阶段(2018-2020年,pi前期)和第三阶段(2021-2023年,pi持续)。使用logistic回归分析人口统计学、镇静实践、UE特征和结果。结果:UE发生率由第1期的3.79%下降至第3期的2.17% (p = 0.002)。气管插管率从45.2%下降到26.7% (p = 0.011),气管切开术率从19.0%下降到2.2% (p p = 0.001), 3期气管切开术的几率下降(OR = 0.345, p = 0.021), 3期气管切开术的几率下降(OR = 0.011, p = 0.016)。再插管的危险因素包括没有插管史和没有进行自主呼吸试验。年龄较大(大于或等于71岁)和阿片类药物尿液毒理学阳性与气管切开术密切相关。结论:PI策略的实施显著降低了计划外拔管、再插管和气管切开术的发生率。这些发现支持ICU气道管理的持续质量改进举措。
Impact of performance improvement strategies on unplanned extubation in an inner-city intensive care unit.
Background: Unplanned extubation (UE) in intensive care units (ICUs) is a significant patient safety concern, associated with increased morbidity and healthcare utilization; the reported rates of UE vary from 1% to 15%. There is sparse data on the effects of multiple performance improvement (PI) strategies to decrease the rate of UE, particularly in inner-city ICU populations. This study evaluates the impact of PI strategies on UE rates and associated patient outcomes in an adult ICU.
Objectives: To determine the impact of performance improvement (PI) strategies on rates of unplanned extubation (UE), reintubation, tracheostomy, mortality, and length of hospital stay in ICU patients.
Design: Retrospective cohort studyMethods:This retrospective observational study included 6,397 mechanically ventilated patients admitted to a single tertiary ICU between 2015 and 2023. Three distinct time periods were compared: Period 1 (2015-2017, pre-PI), Period 2 (2018-2020, early-PI), and Period 3 (2021-2023, sustained-PI). Demographics, sedation practices, UE characteristics, and outcomes were analyzed using logistic regression.
Results: UE incidence declined significantly from 3.79% in Period 1 to 2.17% in Period 3 (p = 0.002). Reintubation rates dropped from 45.2% to 26.7% (p = 0.011), and tracheostomy rates from 19.0% to 2.2% (p < 0.001). Multivariate analysis showed reduced odds of reintubation in Periods 2 (OR = 0.219, p = 0.001) and 3 (OR = 0.345, p = 0.021) and reduced odds of tracheostomy in Period 3 (OR = 0.011, p = 0.016). Risk factors for reintubation included the absence of prior intubation history and not undergoing spontaneous breathing trials. Older age (⩾71 years) and positive urine toxicology for opiates were strongly associated with tracheostomy.
Conclusion: Implementation of PI strategies significantly reduced rates of unplanned extubation, reintubation, and tracheostomy. These findings support continued quality improvement initiatives in ICU airway management.
期刊介绍:
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