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Unplanned extubation in NICU patients: are we speaking the same language?

Journal of Perinatology volume 35, pages 676–677 (2015)Cite this article

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Unplanned extubation (UE) occurring in neonates is a significant patient safety concern, particularly in preterm infants and other critically ill newborns, and as such is increasingly recognized as a quality indicator of patient safety in the neonatal intensive care unit (NICU). Indeed, the most recent US News & World Report Survey identifies ‘unintended extubations’ as an area of focus for NICUs. UE requiring re-intubation ranks as the fourth most common adverse event in the NICU1 and has been associated with hypoxia, hypercarbia, airway trauma, ventilator-associated pneumonia and intraventricular hemorrhage.2, 3, 4 Thus, quality improvement (QI) efforts to reduce UE should be encouraged as a means to promote patient safety and improve patient outcomes.

The first, and perhaps the most challenging, aspect of UE reduction efforts lies in its definition. What is an unplanned extubation? On the surface, it seems like an easily definable event, though the lack of a clear, universal definition is apparent in the literature. The US News & World Report Survey defines UE simply as ‘invasive airway loss’. Loughead et al.5 defined UE as ‘any endotracheal tube (ETT) removal at a time, or fashion, not specifically intended or ordered by a physician’. Merkel et al.6 defined UE similarly, as ‘dislodgement or removal of the ETT from the trachea in a patient receiving invasive mechanical ventilation at a time that was not specifically intended or ordered by a physician’. Other authors refer to UE as ‘premature removal of the ETT by the patient…or by staff during nursing and medical care’.7 Although these definitions appear similar, and some even quite specific, each allow for interpretation during data collection and case review. Ultimately this prohibits the comparison of ‘apples-to-apples’ between NICUs and undermines accurate benchmarking. Moreover, the safety of the fragile neonates may be jeopardized if, through lack of a unified definition of UE, events that carry the potential for harm are not routinely recognized or reported.

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Authors and Affiliations

  1. Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA

    J M Meyers

  2. Department of Pediatrics, Albany Medical Center, Albany, NY, USA

    J Pinheiro

  3. Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY, USA

    M U Nelson

  4. Division of Neonatology, Crouse Hospital, Syracuse, NY, USA

    M U Nelson

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  1. J M Meyers
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Correspondence to J M Meyers.

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Meyers, J., Pinheiro, J. & Nelson, M. Unplanned extubation in NICU patients: are we speaking the same language?. J Perinatol 35, 676–677 (2015). https://doi.org/10.1038/jp.2015.55

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