Implementation strategies used to reduce Unplanned Extubations (UPE) in the Neonatal Intensive Care Unit at The Hospital for Sick Children (SickKids)

Abstract

This study analyzed unplanned extubation (UPE) reduction strategies as well as patient characteristics and other risk factors for all UPEs that occurred between January 1, 2007 and December 31, 2019 in the neonatal intensive care unit (NICU) at the Hospital for Sick Children (SickKids) in Toronto, Canada. Six major implementation strategies decreased UPEs per 100 ventilator days from 2.38 to 0.45 between 2003 and 2019. The study sample included 302 UPEs (252 infants) with 12% infants with repeated UPEs. The study analyzed the association of NICU UPEs with previous UPE history, birth weight, gestational age, taping protocol, procedures prior to UPE, sedation concern, patient restraint, type of endotracheal tube, loose tape, length of mechanical ventilation and length of NICU stay. These findings would be helpful for other healthcare facilities and researchers to inform the development of UPE reduction frameworks, and to improve patient outcomes.