title: Incidence and risk factors of accidental extubation in a neonatal intensive care unit.
abstract: OBJECTIVE
  To determine the incidence and risk factors of accidental extubation (AE) in a tertiary neonatal intensive care unit.
  
  
  METHODS
  A prospective cohort study was conducted to determine AE incidence density per 100 patient-days, during a 23-month period, in 222 newborns receiving assisted ventilation (AV). Logistic regression analysis was used to determine risk factors for AE. The presence of a cyclical pattern in extubation rates, according to the variables of interest, was investigated by Cosinor analysis.
  
  
  RESULTS
  The mean AE rate was 5.34/100 patient-days ventilated. AE-associated predictive variables were: subsequent use of the oral and nasal routes during AV [relative risk (RR) = 4.73; 95% confidence interval (95%CI) 1.92-11.60], AV duration (per day, RR = 1.03; 95%CI 1.02-1.04), and number of patient-days ventilated (RR = 1.01; 95%CI 1.01-1.02). According to the adjusted multiple regression analysis, total AV time was the only independent predictor of AE in this sample (RR = 1.02; 95%CI 1.01-1.03). AV time of 10.5 days showed an accuracy of 0.79 (95%CI 0.71-0.87) for the occurrence of AE. Cosinor analysis showed significant periodicity in overall AE rate and in the number of patient-days ventilated. There was a significant correlation between the number of patient-days ventilated and AE frequency.
  
  
  CONCLUSIONS
  Mean AE density was 5.34/100 patient-days ventilated. AV duration was the only independent predictor of AE. The best accuracy for AE occurrence was achieved at 10.5 days of AV duration.
authors.affiliation: Department of Pediatrics, School of Medicine, Universidade Estadual de Campinas (FCM/UNICAMP), Campinas, SP, Brazil. flcquintana@ig.com.br
authors.forename: Fabiana L
authors.initials: FL
authors.lastname: Carvalho
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Mezzacappa
authors.forename: Roseli
authors.initials: R
authors.lastname: Calil
authors.forename: Helymar da Costa
authors.initials: Hda C
authors.lastname: Machado
mesh_terms: D020878:Device Removal / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors