Neonatal unplanned extubations: an unsolved safety issue



Diana K. Segura-Ramírez, Servicio de Neonatología del Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, España
Sara Fernández-Castiñeira, Servicio de Neonatología del Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, España
Diana C. Gualotuña-Maigua, Servicio de Neonatología del Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, España
Silvia Martín-Ramos, Servicio de Neonatología del Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, España
Sonia Lareu-Vidal, Servicio de Neonatología del Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, España
Gonzalo Solís-Sánchez, Servicio de Neonatología del Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, España


Background: Unplanned extubations are safety events relatively frequent in the neonatal intensive care units (NICU). This study aimed to describe the frequency and characteristics of unplanned extubations in a NICU. Methods: We conducted a retrospective observational study of unplanned extubations in the NICU of a tertiary regional referral hospital. We reviewed medical records for data collection and performed the statistical analysis, comparing the cases of unplanned extubations with those in which it did not occur among all the cases that received intubation and invasive neonatal mechanical ventilation. Results: A total of 958 newborns were admitted to the NICU, of which 174 required assistance with invasive mechanical ventilation (18.1%) and 28 experienced unplanned extubations (16.1%): 25 patients with one episode, one with two episodes, and two with three episodes. The rate was 2.93 unplanned extubations for every 100 days of invasive mechanical ventilation in 5 years, with a significant decrease in the last three years (p = 0.0158). We found a statistically significant correlation between a weight < 1500 g and unplanned extubation in the multivariate analysis, although sedation appears to affect its interaction. Conclusions: Unplanned extubations are a relatively frequent problem, although with a tendency to decrease in recent years. The weight of the patients at birth and sedation during ventilation are important factors in this safety problem.



Keywords: Unplanned extubation. Newborn. Invasive mechanical ventilation. Healthcare safety.