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Reducing Unplanned Pediatric Extubations by Modifying Analgosedative Infusions.

John S Giuliano1, Shannon Hassmann2, Christine Curello2

  • 1From the Department of Pediatrics, Section of Critical Care Medicine, Yale School of Medicine, New Haven, CT.

Pediatric Quality & Safety
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Summary
This summary is machine-generated.

Reducing fentanyl use as a first-line opioid infusion in pediatric intensive care units significantly decreased unplanned extubations (UEs). This quality improvement initiative demonstrated a substantial reduction in UE events, improving patient safety.

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Area of Science:

  • Pediatric critical care medicine
  • Quality improvement science
  • Pharmacology

Background:

  • Unplanned extubations (UEs) are a significant concern in pediatric intensive care units (PICUs).
  • Analgesic and sedative infusions play a critical role in maintaining endotracheal tube (ETT) stability.
  • Fentanyl has been a common first-line opioid for intubated pediatric patients.

Purpose of the Study:

  • To decrease the incidence of unplanned extubations (UEs) in pediatric and pediatric cardiac intensive care units.
  • To reduce the utilization of fentanyl as the primary opioid infusion for intubated patients by 10% within one year.

Main Methods:

  • Implementation of a quality improvement initiative focused on education, sedation standardization, and data transparency.
  • Development and use of a standardized sedative/analgesic infusion order set featuring morphine and hydromorphone.
  • Tracking and transparent sharing of data using statistical process control charts.

Main Results:

  • First-line fentanyl use decreased from 45.5% to 18.1% post-implementation.
  • Unplanned extubations (UEs) decreased from 9 events during the baseline period to 5 events in the subsequent period.
  • The UE rate per 100 ventilator days dropped from 1.03 to 0.10 over 1.5 years.

Conclusions:

  • Adjusting the choice of first-line opioid infusions may be an effective strategy to reduce UEs in intubated pediatric patients.
  • Quality improvement initiatives incorporating education and standardized ordering can successfully alter medication practices.
  • The study highlights the multifactorial nature of ETT maintenance, emphasizing the role of analgosedation.