Unplanned Extubation in the Neonatal ICU: A Systematic Review, Critical Appraisal, and Evidence-Based Recommendations

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dc.contributor.author Silva, Paulo Sergio Lucas da
dc.contributor.author Reis, Maria Eunice
dc.contributor.author Aguiar, Vania Euzebio
dc.contributor.author Fonseca, Marcelo Cunio Machado [UNIFESP]
dc.date.accessioned 2016-01-24T14:31:55Z
dc.date.available 2016-01-24T14:31:55Z
dc.date.issued 2013-07-01
dc.identifier http://dx.doi.org/10.4187/respcare.02164
dc.identifier.citation Respiratory Care. Irving: Daedalus Enterprises Inc, v. 58, n. 7, p. 1237-1245, 2013.
dc.identifier.issn 0020-1324
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/36463
dc.description.abstract OBJECTIVE: To update the state of knowledge on unplanned extubations (UEs) in neonatal ICUs. This review focuses on the following topics: incidence, risk factors, reintubation after UE, outcomes, and prevention. METHODS: the MEDLINE, EMBASE, CINAHL, Scielo, Lilacs, and Cochrane databases were searched for relevant publications from January 1, 1950, through January 30, 2012. Fifteen articles were selected for data abstraction. the search strategy included the following key words: unplanned extubation, accidental extubation, self extubation, unintentional extubation, unexpected extubation, inadvertent extubation, unintended extubation, spontaneous extubation, treatment interference, and airway accident. Study quality was assessed using the Newcastle-Ottawa scale. Grades of recommendation were assessed according to the Oxford Centre for Evidence-Based Medicine's levels of evidence system. Studies with Newcastle-Ottawa scale score >= 5 that included appropriate statistical analysis were deemed of high methodological quality. RESULTS: the overall mean Newcastle-Ottawa scale score was 3.5. UE rates ranged from 0.14 to 5.3 UEs/100 intubation days, or 1% to 80.8%. Risk factors included restlessness/agitation (13-89%), poor fixation of endotracheal tube (8.5-31%), tube manipulation at the time of UE (17-30%), and performance of a patient procedure at bedside (27.5-51%). One study showed that every day on mechanical ventilation increased the UE risk 3% (relative risk 1.03, P < .001). the association between birth weight/gestational age and UE is controversial. Reintubation rates ranged from 8.3% to 100%. There is still a gap of information about strategies addressed to reduce the incidence of UE. the best method of endotracheal tube securement remains a controversial issue. CONCLUSIONS: Despite numerous publications on UE, there are few studies assessing preventive strategies for adverse events and there is a lack of randomized clinical trials. Recommendations are proposed based on the current available literature. en
dc.format.extent 1237-1245
dc.language.iso eng
dc.publisher Daedalus Enterprises Inc
dc.relation.ispartof Respiratory Care
dc.rights Acesso aberto
dc.subject accidental extubation en
dc.subject endotracheal tube en
dc.subject intubation en
dc.subject neonatal ICU en
dc.subject quality improvement en
dc.subject unplanned extubation en
dc.title Unplanned Extubation in the Neonatal ICU: A Systematic Review, Critical Appraisal, and Evidence-Based Recommendations en
dc.type Resenha
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Hosp & Maternidade Santa Joana
dc.description.affiliation Hosp Sevidor Publ Municipal, Pediat Intens Care Unit, Dept Pediat, São Paulo, Brazil
dc.description.affiliation Hosp & Maternidade Santa Joana, Neonatal Intens Care Unit, São Paulo, Brazil
dc.description.affiliation Universidade Federal de São Paulo UNIFESP, Dept Pediat, Pediat Intens Care Unit, São Paulo, Brazil
dc.description.affiliationUnifesp Universidade Federal de São Paulo UNIFESP, Dept Pediat, Pediat Intens Care Unit, São Paulo, Brazil
dc.identifier.doi 10.4187/respcare.02164
dc.description.source Web of Science
dc.identifier.wos WOS:000321939500016



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