Identifying Patients at Risk for Unplanned Extubation in a Pediatric ICU

Abstract

BACKGROUND: Unplanned extubation (UE) poses a substantial risk, potentially resulting in clinical instability, cardiac arrest, and need for re-intubation. Our objective was to develop a UE risk assessment scoring (UERAS) tool to identify contributing factors, facilitate mitigation strategies, and decrease UE. We hypothesized that our UERAS would demonstrate high reliability and UERAS implementation would be associated with UE reduction. METHODS: In a 75-bed pediatric ICU, we developed the UERAS with the range score at 0-18. We predetermined UERAS ≥ 6 as high risk. For inter-rater reliability (IRR), the UERAS was piloted in a 24-bed section of the PICU, where 2 respiratory therapists (RTs) independently evaluated patients undergoing invasive mechanical ventilation. Upon demonstrating high IRR, UERAS was expanded across the 75 beds. Standardized mitigation actions for high-risk patients were developed including immediate clinician alerts via electronic health record chat function and interdisciplinary bedside huddles within 1 h. RESULTS: During March to April 2023, a sample of 50 paired observations by 16 RTs showed a Pearson's correlation coefficient of 0.997 (P