Format

Send to

Choose Destination
Respir Care. 2019 May 28. pii: respcare.06721. doi: 10.4187/respcare.06721. [Epub ahead of print]

The Adverse Impact of Unplanned Extubation in a Cohort of Critically Ill Neonates.

Author information

1
Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
2
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California.
3
Keck School of Medicine, University of Southern California, Los Angeles, California.
4
The Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit, Children's Hospital Los Angeles, Los Angeles, California.
5
Respiratory Care Services, Children's Hospital Los Angeles, Los Angeles, California.
6
Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California. niyer@chla.usc.edu.

Abstract

BACKGROUND:

We sought to describe adverse events associated with unplanned extubation (UE) and to explore risk factors for serious adverse events post-UE among infants who experienced UE.

METHODS:

Data were prospectively collected on all infants who had a UE event at a single institution over a 4-y period. Demographic information and information on outcomes were obtained retrospectively. We described the frequency of post-UE adverse events: success or failure of extubation trial if offered, rate of re-intubation, post-UE changes in ventilator settings, and serious adverse events post-UE (eg, need for cardiopulmonary resuscitation, clinical sepsis, and death or tracheostomy prior to discharge). We used a multivariate logistic regression model to identify the risk factors associated with serious adverse events.

RESULTS:

There were 134 documented UE events. Agitation was the most common known cause. After UE, 49% of the subjects were given a trial of extubation, and 65% of the trials were successful at 48 h. Cardiopulmonary resuscitation (CPR) was performed in 13% of cases. In subjects requiring immediate re-intubation, mean airway pressure (P̄aw) and oxygen requirement increased in 33% and 55% of the subjects, respectively. Post-UE clinical sepsis occurred in 17% of subjects. Higher pre-UE P̄aw and difficult re-intubation were associated with a need for CPR. Subjects who received CPR had increased odds (3.7×) of developing clinical sepsis.

CONCLUSIONS:

UE can result in serious adverse events, including hemodynamic instability and possibly an increased risk for clinical sepsis. Difficult re-intubation was associated with a higher risk of needing CPR and, later, tracheostomy and death.

KEYWORDS:

adverse events; newborn; unplanned extubation

PMID:
31138734
DOI:
10.4187/respcare.06721

Conflict of interest statement

The authors have disclosed no conflicts of interest.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center