title: A prolonged observational study of tracheal tube displacements: Benchmarking an incidence <0.5-1% in a medical-surgical adult intensive care unit.
abstract: OBJECTIVE
  Tracheal tubes are commonly used in intensive care unit (ICU) and lead to complications like displacements. The primary aim of the study was to evaluate if the rate of tracheal tube displacement benchmarked at <1% per patient and <0.5% per tracheal tube day, could be sustained over a prolonged period. The secondary aim was to document the patterns of all forms airway accident and to evaluate their consequences.
  
  
  METHODS
  This was a prospective observational study of Intubated and ventilated patients in a General Medical-Surgical Adult ICU. The incidence of accidental extubation, self extubation, partial displacement and blockages of tracheal tubes were recorded.
  
  
  RESULTS
  The overall tracheal tube displacement rate was 61/10,112 (0.6%) per patient and 61/28,464 (0.22%) per tracheal tube day. There were 30 additional incidents of blockage, kinking or biting of the tracheal tube. Physiological consequences-69 were mild, 10 moderate, 12 major and one death. Of the 91 accidents, 30 were partly and 30 were completely preventable. 76 incidents involved an endotracheal tube (54 displaced, 12 blocked and 10 bitten-kinked) and 15 a tracheostomy tube (seven displaced and eight blocked). Accidents were more common in medical than surgical patients (medical = 48, cardiac surgical = 17 and other surgical/trauma = 26).
  
  
  CONCLUSIONS
  Tracheal tube displacement rate in a mixed medical-surgical adult ICU was maintained below the pre-set benchmark of <1% per patient and <0.5% per intubated day over nearly a decade.
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Farhad N
authors.initials: FN
authors.lastname: Kapadia
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Pandurang C
authors.initials: PC
authors.lastname: Tekawade
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Shruti S
authors.initials: SS
authors.lastname: Nath
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Sharad S
authors.initials: SS
authors.lastname: Pachpute
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Sanjay S
authors.initials: SS
authors.lastname: Saverkar
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Rupali A
authors.initials: RA
authors.lastname: Bhise
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Aarti C
authors.initials: AC
authors.lastname: Chavan
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Sholly J
authors.initials: SJ
authors.lastname: Varghese
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Vidya U
authors.initials: VU
authors.lastname: Kantak
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Rohini V
authors.initials: RV
authors.lastname: Kshirsagar
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Vaishali A
authors.initials: VA
authors.lastname: Neve
authors.affiliation: Department of Intensive Care, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India.
authors.forename: Samona O
authors.initials: SO
authors.lastname: D'souza
keywords: Airway accidents; endotracheal tube; tracheostomy tube; unplanned extubation