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Research ArticleOriginal Research

The Adverse Impact of Unplanned Extubation in a Cohort of Critically Ill Neonates

Kristi Kuhn Kambestad, Aaron Huack, Srikumar Nair, Rachel Chapman, Steven Chin, Leo Langga, Erin Mounger, Edward Guerrero and Narayan P Iyer
Respiratory Care December 2019, 64 (12) 1500-1507; DOI: https://doi.org/10.4187/respcare.06721
Kristi Kuhn Kambestad
Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.Division of Neonatal-Perinatal Medicine, Department of Pediatrics, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California.
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Aaron Huack
Keck School of Medicine, University of Southern California, Los Angeles, California.
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Srikumar Nair
Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.The Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit, Children's Hospital Los Angeles, Los Angeles, California.
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Rachel Chapman
Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.The Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit, Children's Hospital Los Angeles, Los Angeles, California.
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Steven Chin
Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.The Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit, Children's Hospital Los Angeles, Los Angeles, California.
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Leo Langga
Respiratory Care Services, Children's Hospital Los Angeles, Los Angeles, California.
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Erin Mounger
The Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit, Children's Hospital Los Angeles, Los Angeles, California.
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Edward Guerrero
Respiratory Care Services, Children's Hospital Los Angeles, Los Angeles, California.
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Narayan P Iyer
Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.The Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit, Children's Hospital Los Angeles, Los Angeles, California.
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  • For correspondence: niyer@chla.usc.edu
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Abstract

BACKGROUND: We sought to describe adverse events associated with unplanned extubation (UE) and to explore risk factors for serious adverse events post-UE among infants who experienced UE.

METHODS: Data were prospectively collected on all infants who had a UE event at a single institution over a 4-y period. Demographic information and information on outcomes were obtained retrospectively. We described the frequency of post-UE adverse events: success or failure of extubation trial if offered, rate of re-intubation, post-UE changes in ventilator settings, and serious adverse events post-UE (eg, need for cardiopulmonary resuscitation, clinical sepsis, and death or tracheostomy prior to discharge). We used a multivariate logistic regression model to identify the risk factors associated with serious adverse events.

RESULTS: There were 134 documented UE events. Agitation was the most common known cause. After UE, 49% of the subjects were given a trial of extubation, and 65% of the trials were successful at 48 h. Cardiopulmonary resuscitation (CPR) was performed in 13% of cases. In subjects requiring immediate re-intubation, mean airway pressure (̄Paw) and oxygen requirement increased in 33% and 55% of the subjects, respectively. Post-UE clinical sepsis occurred in 17% of subjects. Higher pre-UE ̄Paw and difficult re-intubation were associated with a need for CPR. Subjects who received CPR had increased odds (3.7×) of developing clinical sepsis.

CONCLUSION: UE can result in serious adverse events, including hemodynamic instability and possibly an increased risk for clinical sepsis. Difficult re-intubation was associated with a higher risk of needing CPR and, later, tracheostomy and death.

  • unplanned extubation
  • adverse events
  • newborn

Footnotes

  • Correspondence: Narayan P Iyer MD, Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #31, Los Angeles, CA 90027. E-mail: niyer{at}chla.usc.edu.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2019 by Daedalus Enterprises
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Respiratory Care: 64 (12)
Respiratory Care
Vol. 64, Issue 12
1 Dec 2019
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The Adverse Impact of Unplanned Extubation in a Cohort of Critically Ill Neonates
Kristi Kuhn Kambestad, Aaron Huack, Srikumar Nair, Rachel Chapman, Steven Chin, Leo Langga, Erin Mounger, Edward Guerrero, Narayan P Iyer
Respiratory Care Dec 2019, 64 (12) 1500-1507; DOI: 10.4187/respcare.06721

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The Adverse Impact of Unplanned Extubation in a Cohort of Critically Ill Neonates
Kristi Kuhn Kambestad, Aaron Huack, Srikumar Nair, Rachel Chapman, Steven Chin, Leo Langga, Erin Mounger, Edward Guerrero, Narayan P Iyer
Respiratory Care Dec 2019, 64 (12) 1500-1507; DOI: 10.4187/respcare.06721
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