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Updated: Aug 22, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Continuous quality improvement: reducing unplanned extubations in a pediatric intensive care unit
Roxanne Sadowski1, Ronald E Dechert, Kenneth P Bandy
1Department of Critical Care Support Services, University of Michigan Health System, 200 East Hospital Dr, F5815 Box 0208, Ann Arbor, MI 48109, USA. rsadowsk@umich.edu
Insights
Unplanned extubation (UEX) in pediatric intensive care units is linked to longer ventilation and hospital stays. Targeted interventions and monitoring programs helped reduce UEX rates in children.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Patient Safety
Background:
- Unplanned extubation (UEX) is a significant complication in pediatric intensive care units (PICUs), often leading to increased morbidity.
- Limited data exists on factors contributing to UEX and reintubation in pediatric populations.
- Assessing UEX incidence and associated patient conditions is crucial for improving care.
Purpose of the Study:
- To determine the incidence of UEX in a PICU over a 5-year period.
- To identify patient characteristics and conditions associated with UEX.
- To evaluate the impact of targeted interventions on UEX rates.
Main Methods:
- Prospective data collection on all patients requiring artificial airways in the PICU over 5 years.
- Detailed information gathered for patients experiencing UEX, including demographic and clinical data.
- Implementation and iterative modification of educational sessions and care management protocols based on monitoring findings.
Main Results:
- A total of 164 UEXs occurred in 141 of 2192 patients (6%), with an overall rate of 1.2 UEXs per 100 airway days (AWD).
- The UEX rate decreased from 1.5 to 0.8 per 100 AWD over the study period.
- Younger children (<5 years) had higher UEX rates; UEX patients experienced longer mechanical ventilation (6 vs. 3 days) and PICU stays (8 vs. 4 days).
- Forty-six percent of UEXs occurred during weaning, with 22% requiring reintubation.
Conclusions:
- UEX in pediatric patients is associated with prolonged mechanical ventilation and PICU length of stay.
- A continuous quality improvement program, including monitoring and education, effectively reduced UEX rates.
- Identifying high-risk (younger children) and low-risk (weaning patients for reintubation) populations informed targeted interventions.
Objective:
Unplanned extubation (UEX) is a potentially serious complication of mechanical ventilation. Limited information is available regarding factors that contribute to UEXs and subsequent reintubation of children. We monitored UEXs in our pediatric intensive care unit (PICU) for a 5-year period to assess the incidence and patient conditions associated with UEX and to evaluate whether targeted interventions were associated with a reduced rate of UEXs.
Methods:
Over a 5-year period, demographic and clinical information was collected prospectively on all patients who required an artificial airway while admitted to the PICU. Additional information was collected for patients who experienced an UEX. Educational sessions and care management protocols were developed, implemented, and modified according to issues identified via the monitoring program.
Results:
From a total of 2192 patients who required 13 630 airway days (AWD), 141 (6%) patients experienced 164 UEXs. The overall rate of UEX for the study period was 1.2 UEXs per 100 AWD, and this rate decreased from 1.5 in the first year to 0.8 in the last year. UEXs were more common in children who were younger than 5 years (1.6 vs 0.6 UEX per 100 AWD) compared with older children. The UEX children experienced significantly longer length of mechanical ventilation (6 vs 3 days) and longer length of PICU stay (8 vs 4 days) compared with non-UEX children. Forty-six percent of the UEXs occurred in patients who were weaning from mechanical ventilation, and 22% of those patients required reintubation.
Conclusions:
We conclude that UEX in pediatric patients is associated with longer length of mechanical ventilation and length of stay in the PICU. A continuous quality improvement monitoring and educational program that identified high-risk patients for UEX (younger patients) and patients who were at low risk for subsequent reintubation (weaning patients) contributed to a reduction of these potentially adverse events.
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