EXPERIENCE WITH INTUBATED PATIENTS DOES NOT AFFECT THE ACCIDENTAL EXTUBATION RATE IN PEDIATRIC INTENSIVE-CARE UNITS AND INTENSIVE-CARE NURSERIES

Accidental extubation is a potentially serious event for pediatric or neonatal patients with respiratory failure, especially in clinical set tings in which personnel capable of performing reintubation may not be readily available. Thus the rate of accidental extubation in small in tensive care units that operate without 24-hour in-house physician ava ilability may be an important quality assurance indicator. The objecti ves of this study were to determine the accidental extubation rate at a single small pediatric intensive care unit (PICU) and compare it wit h published reports. This study was carried out in a six-bed PICU at W ashoe Medical Center in Reno, Nevada, with a relatively low level of p atient acuity, as measured by PRISM score and the frequency of intubat ion, and without 24-hour in-house physician availability. All intubate d patients admitted during the 5-year period from January 1, 1989 to D ecember 31, 1993 were included. The primary outcome measure was the oc currence of accidental extubation.We observed only two accidental extu bations in 1,749 intubated-patient-days (IPD) (0.114 accidental extuba tions/100 IPD [95%, confidence interval 0.014-0.413 accidental extubat ions/ 100 IPD]). This rate of accidental extubation was compared with data in published reports from neonatal intensive care units (NICUs) a nd PICUs, which ranged from 0.14 accidental extubations/100 IPD to 4.3 6 accidental extubations/100 IPD. The dependence of the observed accid ental extubation rate on unit size and institutional experience with i ntubated patients, as measured by the average number of intubated pati ents, was examined. We found no evidence that the accidental extubatio n rate is higher in smaller units or units with less institutional exp erience. Low rates can be achieved in small units with low acuity. (C) 1997 Wiley-Liss. Inc.