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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1757625
Original Article

Practice Variability and Unplanned Extubation Rates across Pediatric Intensive Care Units

Krista Wollny 
1   Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
2   Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
3   Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
4   PICU, Alberta Children's Hospital, Calgary, Alberta, Canada
,
Amy Metcalfe
1   Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
3   Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
5   Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
6   Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Karen Benzies
1   Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
2   Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
3   Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
7   Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Simon J. Parsons
4   PICU, Alberta Children's Hospital, Calgary, Alberta, Canada
,
Tolulope Sajobi
1   Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Deborah McNeil
1   Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
2   Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
3   Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
8   Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Alberta, Canada
› Author Affiliations Funding This work was supported by an Alberta Children's Hospital Research Institute Graduate Student Award (K.W.). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Abstract

The purpose of this study was to describe the care of intubated patients in pediatric critical care. Acknowledging there are several perceived factors that contribute to unplanned extubations, a secondary objective was to describe how practice variation may relate to observed differences in unplanned extubation rates. A survey about practices related to the care of intubated patients was distributed to all pediatric intensive care units (PICUs) participating in the Virtual Pediatric Systems (VPS, LLC). Unplanned extubation rates for 2019 to 2020 were obtained from VPS. Univariate and bivariate analyses were performed to describe the responses, with unplanned extubation rates calculated as means. The text responses about perceived causes of unplanned extubation in participants' sites were explored using thematic content analysis. A total of 44 PICUs were included in this study (response rate 37.0%). The mean unplanned extubation rate for the sample was 0.41 (95% confidence interval: 0.31–0.50) per 100 intubation days. Variability was found across several aspects that impact care, including staffing, the frequency of procedures (e.g., chest radiography), and treatment-related goals (e.g., sedation and mobilization). The perceived causes of unplanned extubations in the sample included patient-, staff-, and equipment-related factors. We found practice variability in pediatric critical care units related to the care of intubated patients, which may contribute to the frequency of adverse events. As evidence emerges and professional associations and organizations recommend the best practices, knowledge translation will be required for the implementation and deimplementation of practices to improve the quality of care in PICUs.

Keywords

intensive care units - pediatric - patient safety - extubation - quality improvement - critical care

Supplementary Material



Publication History

Received: 28 June 2022

Accepted: 31 August 2022

Article published online:
01 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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