title: Multicenter Analysis of the Factors Associated With Unplanned Extubation in the PICU.
abstract: OBJECTIVE
  To identify factors associated with unplanned extubation in PICUs.
  
  
  METHODS
  A prospective, case-controlled multicenter study.
  
  
  METHODS
  Eleven Pediatric Intensive Care Units collaborating through the National Association of Children's Hospitals and Related Institutions PICU focus group.
  
  
  METHODS
  Patients with unplanned extubation events and control patients without unplanned extubation.
  
  
  METHODS
  Unplanned extubation events were prospectively tracked for 1 year at 11 centers. When an unplanned extubation occurred, up to four controls were randomly identified of other intubated patients in the unit. For each event and control, data associated with unplanned extubation events, reintubation, and outcomes were collected.
  
  
  RESULTS
  One hundred eighty-nine unplanned extubation events occurred out of 25,500 endotracheal tube days in the study (0.74 unplanned extubations/100 endotracheal days; 95% CI, 0.64-0.85), with 654 associated controls. Unplanned extubation rates ranged by site from 0.3 to 2.1 unplanned extubations/100 endotracheal days. Children less than 6 years had an increased rate of unplanned extubation (0.83 for < 6 yr vs 0.45 for ≥ 6 yr; p = 0.001). After multivariate analysis, inadequate patient sedation (odds ratio, 9.1; 95% CI, 4.5-18.5), loose or slimy endotracheal tube (odds ratio, 10.4; 95% CI, 5.0-22.2), a planned extubation in the next 12 hours (odds ratio, 2.3; 95% CI, 1.3-4.1), and a nurse pulled from another unit (odds ratio, 3.8; 95% CI, 1.4-9.9) were associated with unplanned extubation. Sixty percent of unplanned extubations required reintubation.
  
  
  CONCLUSIONS
  The rate of unplanned extubation is higher in patients aged less than 6 years. Patient factors, such as decreased level of sedation, loose or slimy endotracheal tube, and staffing factors such as floating nurse from another unit, contribute to unplanned extubation in children.
authors.affiliation: 1Pediatric Critical Care, Helen De Vos Children's Hospital, Grand Rapids, MI. 2Grand Rapids Medical Education Partners, Milwaukee, WI. 3Critical Care Section, Medical College of Wisconsin, Pediatrics and Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Fitzgerald
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.forename: Sheila J
authors.initials: SJ
authors.lastname: Hanson
mesh_terms: D060666:Airway Extubation / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors