ISSN:
1432-1238
Keywords:
Key words Mechanical ventilation
;
Endotracheal intubation
;
Unplanned
;
extubation
;
Self-extubation
;
Intensive care unit
;
Quality
;
improvement
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Objective: To evaluate the effectiveness of a continuous quality improvement (CQI) program in reducing the incidence of unplanned endotracheal extubation. Design: Prospective study over a 9-month period. Setting: Adult intensive care units (ICUs including coronary care unit, medical ICU, surgical ICU, and cardiovascular surgical ICU) in a university-affiliated medical center. Patients: 831 consecutive mechanically ventilated patients. Interventions: CQI program focusing on standardization of procedures, improvement of communication, and identification and management of high-risk patients. Measurements and results: With the implementation of this CQI program, the overall incidence density of unplanned extubation (defined as number of new unplanned extubations per mechanical ventilation patient-days) significantly decreased from 2.6% in the first trimester to 1.5% in the second trimester and 1.2% in the third trimester (p=0.01). This reduction was essentially the result of a decrease in unplanned extubation in orally intubated patients (incidence density 4.6, 1.7 and 1.0% for three trimesters, respectively; p〈0.0001). Unplanned extubation in nasally intubated patients remained largely unaffected (1.2, 1.4, and 1.4% for three trimesters, respectively; p=0.92). Conclusions: The implementation of a concerted CQI program is effective in reducing the overall incidence of unplanned endotracheal extubation.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01709348
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