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Unplanned extubation

Laurene Aydon, Margo Zimmer, Mary Sharp
AIM: The aim of this study was to highlight the incidence of unplanned extubation (UE) and identify associated factors in our neonatal population. METHODS: This study was a prospective audit. RESULTS: A specifically designed audit tool was used to capture UE events; 182 neonates required mechanical ventilation for 863 days. There were 41 episodes of UE. The UE rate was 4.75 per 100 days of ventilation. At the time of UE, median gestational age of patients was 27...
February 24, 2018: Journal of Paediatrics and Child Health
Rajesh M Shetty, Antonio Bellini, Dhuleep S Wijayatilake, Mark A Hamilton, Rajesh Jain, Sunil Karanth, ArunKumar Namachivayam
BACKGROUND: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools...
February 21, 2018: Cochrane Database of Systematic Reviews
Rebecca E Thomas, Shripada C Rao, Corrado Minutillo, Bruce Hullett, Max K Bulsara
BACKGROUND: Cuffed endotracheal tubes are being increasingly used in infants; however, current evidence in the literature mostly includes infants ≥ 3-kg weight. AIMS: The aim of this observational study was to compare the short-term outcomes with the use of Microcuff® cuffed vs uncuffed endotracheal tubes in neonates < 3 kg. METHODS: We performed a retrospective cohort study in a single-centre, tertiary children's hospital neonatal intensive care unit...
January 9, 2018: Paediatric Anaesthesia
Samantha Freeman, Janelle Yorke, Paul Dark
AIM: To critically review the evidence relating to the management of agitation within the Adult Critical Care Unit (ACCU) environment and identify any risks and benefits of current management strategies. BACKGROUND: Admission to an ACCU can be traumatic and potentially life altering for the patient. Patient agitation is common in ACCUs and is associated with the potential for harm. Despite inherent safety risks, there is a paucity of evidence-based guidance underpinning the care of agitation in patients with critical illness...
January 4, 2018: Journal of Clinical Nursing
R Al-Abdwani, C B Williams, C Dunn, J Macartney, K Wollny, H Frndova, N Chin, D Stephens, C S Parshuram
PURPOSE: Unplanned extubation represents loss of control in the ICU, is associated with harm and is used as a measure of quality of care. We evaluated the rates and consequences of unplanned extubation. MATERIALS AND METHODS: Eligible patients were intubated, <18years, and in ICU. Patient, care-related and environmental characteristics were compared in patients who did and did not receive positive pressure ventilation in the 24h after events. Rates are expressed per 100 intubation-days...
December 24, 2017: Journal of Critical Care
Keith D Lamb, Sarah K Spilman, Trevor W Oetting, Julie A Jackson, Matthew W Trump, Sheryl M Sahr
INTRODUCTION: It has been suggested that use of a high-flow nasal cannula (HFNC) could be a first-line therapy for patients with acute hypoxic respiratory failure. The purpose of this study was to determine if protocolized use of HFNC decreases unplanned intubation and adverse outcomes in an ICU population. METHODS: The study was a prospective evaluation of 2 cohorts who received HFNC per protocol. Control groups were retrospective selections of subjects who received HFNC in the pre-protocol period...
March 2018: Respiratory Care
Chiara Cosentino, Mattia Fama, Chiara Foà, Giorgia Bromuri, Serena Giannini, Marco Saraceno, Angela Spagnoletta, Mbemo Tenkue, Elena Trevisi, Leopoldo Sarli
BACKGROUND AND AIM: Unplanned extubations (UE) are getting more and more relevant in Critical Care, becoming a quality and care safeness outcome. This happens because after an UE the patient can face some complications concerning the airway management, respiratory and hemodynamic problems, lengthen in the hospital stay and in the mechanical ventilation time.  The aim of this review is identify and classify the factors that could increase UE risk. METHODOLOGY: A systematic review of scientific articles was performed consulting the databases PubMed, Cinahl, Medline, EBSCOhost and Google Scholar...
November 30, 2017: Acta Bio-medica: Atenei Parmensis
Xiaojing Hu, Yuxia Zhang, Yun Cao, Guoying Huang, Yan Hu, Alexa McArthur
BACKGROUND: Adverse events of mechanically ventilated neonates such as unplanned extubations may be associated with serious negative outcomes. Unplanned extubation rates have been monitored by many neonatal intensive care units as a quality of care metric. OBJECTIVES: The objective was to implement evidence-based best practice and assess the effects of these strategies on minimizing unplanned extubation in the neonatal intensive care unit in a large tertiary children's hospital...
November 2017: JBI Database of Systematic Reviews and Implementation Reports
Kathryn M Wagner, Jeffrey S Raskin, Nicholas P Carling, Mary A Felberg, Megha K Kanjia, I-Wen Pan, Thomas G Luerssen, Sandi Lam
No abstract text is available yet for this article.
November 3, 2017: World Neurosurgery
Cássia Toledo, Flávio Eduardo Nácul, Marcos Freitas Knibel, Nilton Brandão Silva, Ederlon Rezende, Cintia Magalhães Carvalho Grion, Murillo Assunção, Fernando Gutierrez, Joelma Villafanha Gandolfi, Suzana Margareth Lobo
BACKGROUND: Postoperative complications are the primary determinants of survival following major surgery. We aimed to characterize the early perioperative risk factors for postoperative pulmonary complications (POPCs) in patients undergoing major non-cardiac surgeries. METHODS: This study utilized a multicenter prospective observational cohort design. Adult patients undergoing non-cardiac surgeries and admitted to 21 Brazilian ICUs were screened for inclusion in the study...
2017: Anaesthesiology Intensive Therapy
Matthew W T Curran, Edward E Tredget
The stabilization of endotracheal tubes in the burn population presents many problems. Access to the face for dressings, debridements, and the use of topical antimicrobials prevent adequate stabilization of the endotracheal tube with commonly used methods. Conventional methods have an increased risk of shifting, which can lead to injury to the friable burned tissue or unplanned extubation. To prevent these complications, alternative methods using the dentition to stabilize the endotracheal tube have been described...
August 2017: Plastic Surgery
Brian D Leland, Mara E Nitu, Maureen Hancock, Karen Moody, Richard Gunderman, Elizabeth Moser, Courtney M Rowan
OBJECTIVES: To evaluate whether a pediatric intensive care unit initiative promoting physical contact between caregiver and patient improves caregiver spiritual wellbeing. The secondary objectives were to evaluate caregiver perceptions of care before and after the initiative and to follow unplanned extubation rate as a marker of safety of the initiative. We hypothesized that caregiver spiritual wellbeing and caregiver perceptions of care would improve with implementation of our physical contact initiative known as Project ROSE (Reach Out, Soothe, and Embrace)...
December 2017: Journal of Pediatrics
Li-Ching Lin, Yann-Fen C Chao, Pi-Chu Lin
BACKGROUND: Patients with endotracheal intubation often experience anxiety because they are unable to express their needs freely. However, the family members of these patients are able to provide encouragement, comfort, and substantive support. PURPOSE: The aims of the present study were: (1) to compare the anxiety scores, vital signs, and incidence of unplanned extubation (UE) between the two comparison groups; (2) to compare the differences in vital signs before and after the intervention in the experimental group; and (3) to explore the satisfaction of patients in the experimental group with the intervention...
October 2017: Hu Li za Zhi the Journal of Nursing
Paulo Sérgio Lucas da Silva, Marcelo Cunio Machado Fonseca
PURPOSE: Although several studies assess unplanned extubation (UE) in children, few have addressed determinants of UE and factors associated with reintubation in a case-controlled manner. We aimed to identify the risk factors and outcomes associated with UE in a pediatric intensive care unit. METHODS: Cases of UE were randomly matched with control patients at a ratio of 1:4 for age, severity of illness, and admission diagnosis. For cases and controls, we also collected data associated with UE events, reintubation, and outcomes...
January 1, 2017: Journal of Intensive Care Medicine
Paulo Sérgio Lucas da Silva, Daniela Farah, Marcelo Cunio Machado Fonseca
In 2010, recommendations for preventing unplanned extubations (UEs) in pediatric patients were published based on a literature review. Since then, there have been an increasing number of publications related to UE focusing on children. If the introduction of care bundles and larger body of evidence on UE had impact on UE occurrence, this would have important implications on clinical practice. We searched for relevant publications published between Jan 1, 2010 and Jun 30, 2016 in the MEDLINE, EMBASE, and Cochrane systems...
November 2017: Heart & Lung: the Journal of Critical Care
Jian-Fei Xie, Si-Qing Ding, Zhu-Qing Zhong, Sai-Nan Zeng, Chun-Xiang Qin, Qi-Feng Yi, Li-Na Gong, Jian-da Zhou
Positive perceptions of patient safety culture are associated with lower rates of adverse events, but they have not been widely established in many health care organizations. The purpose of this study is to examine the impacts of a safety culture training program (SCTP) on enhancing the perceptions of patient safety in nurse managers. This was a quasi-experimental design. 83 nurse managers were recruited from five randomly selected 2nd level hospitals. Sixty-seven nurse managers received training under the educational SCTP...
November 2017: Nurse Education in Practice
Rebecca E Thomas, Shripada C Rao, Corrado Minutillo, Shyan Vijayasekaran, Elizabeth A Nathan
OBJECTIVE: To analyse current incidence and risk factors associated with severe acquired subglottic stenosis (SASGS) requiring surgical intervention in neonates. DESIGN: Retrospective case-control study. SETTING: Sole tertiary children's hospital. PARTICIPANTS: Patients who underwent surgical intervention for SASGS from January 2006 to December 2014. For each neonatal intensive care unit (NICU) graduate with acquired SASGS, two controls were selected (matched for gestation and year of birth)...
September 2, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
Kristina A Betters, Kiran B Hebbar, David Farthing, Brittany Griego, Tricia Easley, Hartley Turman, Lauren Perrino, Stephanie Sparacino, Mary L deAlmeida
PURPOSE: Early mobility (EM) is being used in adult ICUs in an effort to treat and prevent intensive care unit acquired weakness (ICU-AW) and Post-Intensive Care Syndrome (PICS). Data supports children suffer from ICU-AW and PICS as well. Our objective was to create and implement an EM protocol for pediatric patients receiving invasive mechanical ventilation. METHODS: A multidisciplinary EM committee was formed to create and implement an EM protocol in a quarternary care PICU...
October 2017: Journal of Critical Care
Chien-Ming Chao, Mei-I Sung, Kuo-Chen Cheng, Chih-Cheng Lai, Khee-Siang Chan, Ai-Chin Cheng, Shu-Chen Hsing, Chin-Ming Chen
This study investigated the prognostic factors and outcomes of unplanned extubation (UE) in patients in a medical center's 6 intensive care units (ICUs) and calculated their mortality risk. We retrospectively reviewed the medical records of all adult patients in Chi Mei Medical Center who underwent UE between 2009 and 2015. During the study period, there were 305 episodes of UE in 295 ICU patients (men: 199 [67.5%]; mean age: 65.7 years; age range: 18-94 years). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16...
August 17, 2017: Scientific Reports
Patoula G Panagos, Stephen A Pearlman
Neonates requiring intensive care are at high risk for medical errors due to their unique characteristics and high acuity. Designing a safer work environment begins with safe processes. Creating a culture of safety demands the involvement of all organizational levels and an interdisciplinary approach. Adverse events can result from suboptimal communication and lack of a shared mental model. This chapter describes tools to promote better patient safety in the NICU through monitoring adverse events, improving communication and using information technology...
September 2017: Clinics in Perinatology
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