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首页> 外文期刊>The journal of maternal-fetal & neonatal medicine >Bundle to reduce unplanned extubation in a neonatal intensive care unit
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Bundle to reduce unplanned extubation in a neonatal intensive care unit

机译：捆绑以减少新生儿重症监护单位中的意外拔管

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Objective:To evaluate the effectiveness of a bundle to reduce unplanned extubations (UE) in ventilated newborn infants (NB) and to verify the factors associated to UE. Method:Intervention study with a historical control group in a university hospital neonatal intensive care unit (NICU) between June 2014-May 2015 (Period I) and September 2015-August 2016 (Period II). All ventilated NB were included except those with facial malformations. The bundle (new tracheal tube fixation model, team training, identification of NB at risk of UE, and debriefing after UE episodes) was implemented between Periods I and II. Rates of UE/100 NB ventilated-day were compared between periods for the entire sample and according to the cause: accidental or by medical indication. Factors associated to the first UE episode of each NB were studied by logistic regression. Results:A total of 231 intubations were performed in 120 infants in Period I (gestational age 33.6 +/- 4.7 W; birth weight: 2020 +/- 929 g) and 212 intubations in 131 infants in Period II (34.2 +/- 4.7 W; 2080 +/- 997 g). UE occurred in 19.9% and 14.6% of the NB, in Periods I and II, respectively. Accidental extubation and change of the tube by medical indication were observed in 58.7% and 41.3% of UE in Period I and in 51.6% and 48.4% in Period II. Higher birth weight, lower SNAPPE-II score, and daytime period were associated with a lower chance of UE in all newborns. Conclusion:The bundle did not reduce the UE in NB ventilated in NICU but continued control of UE rates is crucial for improved care, especially for immature and critically neonates. What is new about the paper?The study presented a strategy for assessing the causes of unplanned extubations in a Neonatal Intensive Care Unit, considering not only the accidental extubations, but aldo the medical ordered extubations, which contributes to the definition of actions for the reduction of unplanned extubations in the NICU setting.
机译：目的：评价捆绑的有效性，以减少通风新生儿（NB）中的无计计划的拔管（UE），并验证与UE相关的因素。方法：2015年6月至2015年5月至2015年5月至2015年5月至2015年9月（截至2016年8月）和2016年9月（期间II）的历史对照组进行干预研究。除了具有面部畸形的人之外，包括所有通风NB。在时期I和II之间实施了捆绑包（新的气管管固定模型，识别UE风险的NB和UE发作后的汇报）。在整个样品的时期和根据原因之间比较UE / 100 NB通气日的速率：意外或通过医学指示。通过Logistic回归研究了与每个NB的第一UE集发作相关的因素。结果：在II期间120次婴儿中，在120名婴儿中进行了总量的231个插管;在期间II期间131名婴儿的212个插管（34.2 +/- 4.7 W; 2080 +/- 997 g）。 UE分别发生在19.9％和14.6％的NB，分别在I和II期间。通过医学指示在58.7％和41.3％的UE中观察到管材的意外拔管和变化，在II期间的51.6％和48.4％。较高的出生体重，降低的Snappe-II分数和白天期间与所有新生儿中UE的机会较低。结论：束在NICU通气的NB中没有减少UE，但继续控制UE率对于改善的护理至关重要，特别是对于不成熟和批判性新生儿。关于该文件的新内容？该研究提出了评估新生儿重症监护单元中无计划的拔管原因的策略，不仅考虑了意外拔管，而且Aldo医疗有助于拔管，这有助于减少诉讼的定义在Nicu设置中的意外拔管。

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