Revisiting unplanned extubation in the pediatric intensive care unit: What's new?

Area of Science:

• Pediatric critical care medicine
• Patient safety research
• Respiratory care interventions

Background:

• Previous recommendations for preventing unplanned extubations (UEs) in pediatric patients were published in 2010.
• Since 2010, there has been a notable increase in research concerning UEs in pediatric populations.
• The impact of care bundles and evolving evidence on UE occurrence requires evaluation for clinical practice implications.

Purpose of the Study:

• To review the literature on unplanned extubations (UEs) in pediatric patients published between 2010 and 2016.
• To identify the incidence and primary risk factors associated with pediatric UEs.
• To assess potential areas for improvement in clinical practice through care bundle strategies.

Main Methods:

• Systematic literature search conducted in MEDLINE, EMBASE, and Cochrane databases.
• Inclusion criteria focused on publications from January 1, 2010, to June 30, 2016.
• Data abstraction performed on eligible articles, with a focus on methodological quality.

Main Results:

• Eight articles met the eligibility criteria for data abstraction; three were of high methodological quality.
• The mean incidence of UEs was 1.19 per 100 intubation days.
• Primary risk factors identified include caregiver bedside procedures, patient agitation, and endotracheal tube care.

Conclusions:

• The ideal incidence of unplanned extubations (UEs) in pediatric patients is yet to be determined.
• Key risk factors identified suggest that unit process changes, potentially via care bundle implementation, could reduce UE occurrence.
• Further research and implementation of targeted strategies are warranted to minimize pediatric UEs.