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  • Quality Improvement Article
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Use of an airway bundle to reduce unplanned extubations in a neonatal intensive care unit

Journal of Perinatology volume 44, pages 314–320 (2024)Cite this article

Subjects

Abstract

Background

Following the opening of an infant cardiac neonatal intensive care unit, our aim was to determine a baseline UE rate and implement initiatives to target a goal less than 0.5 UEs/100 ventilator days.

Methods

We utilized the Model for Improvement. Key stakeholders included neonatal providers, nurses, and respiratory therapists. We focused on the creation of an airway bundle that addressed securement methods, communication and education.

Results

From October 2017 to January 2018, our baseline UE rate was 0.92 UEs/100 ventilator days. Subsequent to the implementation of an airway bundle with high compliance, we observed a significant change in the centerline (0.45 to 0.02 UEs/100 ventilator days) during the spring of 2021, followed by a period of 480 days with no UEs.

Conclusion

In a unit where UEs were infrequent events, high compliance with an airway bundle led to a significantly sustained decrease in our UE rates.

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Fig. 1: Key driver diagram for reduction of unplanned extubations in the NICU.
Fig. 2: Endotracheal tube depth communication and securement methods.
Fig. 3: U chart with unplanned extubation rates over a 5-year period.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We want to thank our nursing champions, respiratory therapists, radiology technicians, neonatology providers, Dr. Ganga Krishnamurthy, Dr. Nimrod Goldshtrom, Dr. Rakesh Sahni, Dr. Jen-Tien Wung, Dr. John Babineau, Aalya Chippa, Cynthia Okerfelt, Lynn Kim and clinical systems engineers at NewYork-Presbyterian for their support and guidance throughout this project. There was no external funding for this manuscript.

Funding

All authors have indicated they have no financial relationships relevant to this article to disclose.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, NewYork- Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA

    Faith Kim, Victoria Blancha Eckels, Sandhya S. Brachio, Cristina Brooks, Caitlin Ehret, Gloria Gomez, Sylvia Villaraza-Morales & Diana Vargas

  2. Columbia University Irving Medical Center, New York, NY, USA

    Faith Kim, Sandhya S. Brachio & Diana Vargas

  3. Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Jessica E. Shui

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  1. Faith Kim
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Contributions

Drs. Shui and Vargas conceptualized and designed the study and data collection instruments, and reviewed and revised the manuscript. Dr. Kim designed the data collection instruments, collected data and carried out the initial and final draft of the manuscript. Dr. Blancha Eckels collected data, reviewed and revised the manuscript. Dr. Brachio carried out the initial and final analyses, and reviewed and revised the final manuscript. Ms. Gomez, Brooks and Villaraza-Morales helped to design the data collection instruments, collected and audited data on a regular basis and reviewed and revised the final manuscript. Ms. Ehret reviewed the final analyses and revised the final manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Faith Kim.

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Kim, F., Eckels, V.B., Brachio, S.S. et al. Use of an airway bundle to reduce unplanned extubations in a neonatal intensive care unit. J Perinatol 44, 314–320 (2024). https://doi.org/10.1038/s41372-024-01879-6

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