Effect of Anatomical and Developmental Factors on the Risk of Unplanned Extubation in Critically Ill Newborns

L. Dupree Hatch; Peter H. Grubb; Melinda H. Markham; Theresa A. Scott; William F. Walsh; James C. Slaughter; Ann R. Stark; E. Wesley Ely

doi:10.1055/s-0037-1603341

American Journal of Perinatology, Table of Contents

Am J Perinatol 2017; 34(12): 1234-1240
DOI: 10.1055/s-0037-1603341

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Anatomical and Developmental Factors on the Risk of Unplanned Extubation in Critically Ill Newborns

Authors

L. Dupree Hatch

¹Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
Peter H. Grubb

¹Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
Melinda H. Markham

¹Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
Theresa A. Scott

¹Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
William F. Walsh

¹Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
James C. Slaughter

²Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
Ann R. Stark

¹Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
E. Wesley Ely

³Division of Allergy, Pulmonary, and Critical Care Medicine and the Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee

⁴Veteran's Affairs Tennessee Valley Geriatric Research Education and Clinical Center, Nashville, Tennessee

Abstract

Objective To quantify the daily risk of unplanned extubation (UE) in newborns based on developmental and anatomical factors.

Methods Prospective cohort of ventilated newborns over an 18-month period in a level IV neonatal intensive care unit (NICU). We captured UEs through four data streams. We generated multivariable logistic regression models to assess the association of UE with chronological age, birth weight, and postmenstrual age.

Results During the study, 718 infants were ventilated for 5,611 patient days with 117 UEs in 81 infants. The daily risk of UE had a significant, nonlinear relationship (p < 0.01) with chronological age, decreasing until day 7 (odds ratio [OR]: 0.5; 95% confidence interval [CI]: 0.17–1.47) and increasing after day 7 (day 7–28, OR: 1.36, 95% CI: 1.06–1.75; and >28 days, OR: 1.06, 95% CI: 1.0–1.14). Birth weight and postmenstrual age were not associated with UE. Adverse events occurred in 83/117 (71%) UE events. Iatrogenic causes of UE were more common in younger, smaller infants, whereas older, larger infants were more likely to self-extubate.

Conclusion The daily risk and causes of UE change over the course of an infant's NICU hospitalization. These data can be used to identify infants at the highest risk of UE for whom targeted proactive interventions can be developed.

Keywords

unplanned extubation - patient safety - mechanical ventilation - neonates

Full Text

References

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