Impact of a quality improvement intervention on the incidence of unplanned extubations in a Pediatric Intensive Care Unit.

INTRODUCTION An unplanned extubation (UEX) is a frequent and preventable adverse event of mechanical ventilation. OBJECTIVES To fnd out the causes of unplanned extubation and assess the use of a quality improvement intervention to reduce this event rate. POPULATION Patients with invasive mechanical ventilation for more than 12 hours over the period from May 1st 2010 and April 30th 2011 in a Pediatric Intensive Care Unit (PICU). DESIGN Uncontrolled, before and after study. A quality improvement intervention was used over the period between November 2010 and April 2011, which included training PICU staff, establishing standards to fx the endotracheal tube and control its fxation. RESULTS There were 395 patients admitted to the PICU, 262 (66%) were on mechanical ventilation for more than 12 hours. A total of 27 patients had 30 UEX events: 22 during the period between May and October 2010, and 8 during the period between November 2010 and April 2011. The most common causes of UEX were incorrect fxation of the endotracheal tube (n= 11) and the use of a procedure of care (n= 11). Patients with UEX required additional days on mechanical ventilation: 7 (3-15.5) versus 5 (2-8) days; p= 0.077 and hospitalization: 9.5 (5-19) versus 7 (4-10) days; p= 0.049. During the implementation of the quality improvement intervention, the mean incidence of UEX decreased from 2.30 (95% CI: 1.12-3.49) to 0.86 (95% CI: 0.27-1.44) per 100 days of mechanical ventilation (p= 0.037). CONCLUSIONS The most common causes of UEX were the incorrect fxation of the endotracheal tube and the use of a procedure of care. The implementation of a quality improvement intervention reduced the incidence of UEX.