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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1759878
Original Article

Unplanned Extubations in Pediatric Critical Care: A Case–Control Study

Authors

  • Krista Wollny

    1   Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
    2   Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
    3   Pediatric Intensive Care Unit, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada

  • Cameron B. Williams

    1   Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
    4   Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada

  • Raghad Al-Abdwani

    5   Pediatric Critical Care Medicine, Sultan Qaboos University Hospital, Seeb, Oman

  • Carol Cartelle

    6   Critical Care Program, Hospital for Sick Children, Toronto, Ontario, Canada

  • Jason Macartney

    6   Critical Care Program, Hospital for Sick Children, Toronto, Ontario, Canada

  • Helena Frndova

    6   Critical Care Program, Hospital for Sick Children, Toronto, Ontario, Canada

  • Norbert Chin

    6   Critical Care Program, Hospital for Sick Children, Toronto, Ontario, Canada

  • Christopher Parshuram

    6   Critical Care Program, Hospital for Sick Children, Toronto, Ontario, Canada
    7   Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
    8   Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Abstract

The aim of this study was to quantify associations between the risk of unplanned extubation and patient-, environment-, and care-related factors in pediatric critical care and to compare outcomes between children who did and did not experience an unplanned extubation. This is a retrospective case–control analysis including patients <18 years who experienced an unplanned extubation during intensive care unit (ICU) admission (2004–2014). Cases were matched by age, duration of mechanical ventilation, and date to control patients (4:1) who were intubated but did not experience an unplanned extubation. Conditional logistic regression was used to evaluate associations between unplanned extubations and the abstracted characteristics. We identified 1,601 eligible controls matched to 458 case patients. When adjusted for confounders, eight variables were associated with unplanned extubation: three patient-related factors (previous ICU admission, previous intubation, and the volume of secretions); one environment-related factor (patient room setup); and four care-related factors (intubation route, and the use of sedation, muscle relaxation, and restraints). Patients who had an unplanned extubation had longer length of stay, but lower rate of mortality. This is the largest case–control study identifying variables associated with unplanned extubation in pediatric critical care. Several are potentially modifiable and may provide opportunities to improve quality of care in controlled ICU environments.

Keywords

intensive care units - pediatric - patient safety - intubation - critical care

Contributor and Guarantor Information

All those designated as authors (K. W., C. B. W., R. A., C. C., J. M., H. F., N. C., C. P.) have met all four ICMJE criteria for authorship:


1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND


2. Drafting the work or revising it critically for important intellectual content; AND


3. Final approval of the version to be published; AND


4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


K. W., C. B. W., R. A., and C. P. were the core team leading the study.


K. W., C. B. W., R. A., H. F., and C. P. obtained, reviewed, and cleaned the data.


K. W. and C. P. analyzed the data.


K. W. and C. P. interpreted the evidence.


K. W., C. B. W., R. A., C. C., J. M., H. F., N. C., and C. P. provided advice at different stages.


K. W., C. B. W., R. A., C. C., J. M., H. F., N. C., and C. P. approved the final version of the manuscript.


C. P. is the guarantor and attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.


C. P. affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.


Ethical Approval

Ethical approval was received from the SickKids Research Ethics Board (Ethics ID: 1000039165).


Data Sharing and Code Availability

The data that support the findings of this study are available with reasonable request by contacting the authors.


This work was completed at the Hospital for Sick Children, Toronto, Canada.


Supplementary Material



Publikationsverlauf

Eingereicht: 22. September 2022

Angenommen: 12. November 2022

Artikel online veröffentlicht:
26. Dezember 2022

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