Incidence of unplanned extubations in a neonatal intensive care unit. A before and after study

Introduction: Unplanned extubations (UE) of mechanically ventilated newborns involves an undesirable increase in morbidity and mortality. Objective: A 2-stage study compared the frequency of UE in a Neonatal Intensive Care Unit before and after the implementation of a program of preventive measures to decrease UE. Patients and methods: A before and after prospective study included all mechanically ventilated newborns participating in the 2 stage study from May-December 2011 and June-December 2012. In stage 1, the rate of UE per 100 intubated patient days was calculated and the characteristics of unplanned extubated newborns, circumstances of UE occurrence and need for re-intubation were studied. Consequently, a program of preventive measures for UE was designed and implemented, with the same variables being analysed in stage 2. Results: No differences were found in patient characteristics during the two stages. Stage 1, incidence of UE was 5/100 intubated patient days; Stage 2, 4.5 UE/100 intubated patient days (P=.657). In both stages, most UE occurred during patient handling with re-intubation incidence at 77.4% and 67.7%, respectively. The combined rate of both stages during summer months of July, August and September was 6.2 UE/100 intubation days, in contrast with the remaining months of both stages: UE incidence rate, 3.4 UE/100 intubation days (p=.043). Conclusions: The implementation of a preventive measures program did not significantly reduce the incidence of UE. The summer period showed the highest incidence of UE. (C) 2013 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L. All rights reserved.