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A quality improvement strategy to reduce unintended extubation in the very low birth weight infant: A case report

N Chahin1, M S Yitayew1, L Shaver2

  • 1Children's Hospital of Richmond at VCU and School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.

Journal of Neonatal-Perinatal Medicine
|March 8, 2024
PubMed

Insights

Unintended extubations in very low birthweight infants were significantly reduced by implementing a standardized system. The rate dropped from 3.23 to 0.64 per 100 ventilator days, demonstrating effective protocol adaptation.

Area of Science:

  • Neonatal Intensive Care
  • Pediatric Critical Care
  • Medical Device Management

Background:

  • Unintended extubations are a frequent complication in neonatal intensive care units (NICUs), particularly affecting very low birthweight (VLBW) infants.
  • Efforts are underway to achieve a median rate of fewer than 2 unintended extubations per 100 ventilator days, as defined by the Vermont Oxford Network.
  • This study aimed to decrease unintended extubations in VLBW infants at a large delivery hospital to a target of ≤2 per 100 ventilator days.

Purpose of the Study:

  • To reduce the incidence of unintended extubations in very low birthweight infants within a large delivery hospital setting.
  • To implement and evaluate the effectiveness of the Children's National unintended extubation system.
  • To achieve a sustained reduction in unintended extubation rates to ≤2 per 100 ventilator days.

Main Methods:

  • A collaborative effort between two academic health institutions was established.
  • The Children's National unintended extubation system was implemented, focusing on enhanced endotracheal tube securement and surveillance protocols.
  • Training and consistent application of the system were key components of the methodology.

Main Results:

  • The unintended extubation rate decreased significantly from 3.23 to 0.64 per 100 ventilator days.
  • Following implementation from 2018-2020, a sustained reduction to 1.54 unintended extubations per 100 ventilator days was observed.
  • The most common times for events were between 12:00 pm - 4:00 pm, with spontaneous dislodgement (25%) and dislodgment during repositioning (19%) being the primary causes.

Conclusions:

  • Very low birthweight infants pose unique challenges for endotracheal tube maintenance due to physiological and anatomical changes.
  • Successful reduction of unintended extubations in this vulnerable population is achievable.
  • Adapting successful protocols developed for older infants is a viable strategy for improving outcomes in VLBW infants.
Abstract

Keywords:
Collaborativeunplanned extubationsvery low birthweight infant

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