Risk factors for unplanned extubation in ventilated neonates in South Korea

Abstract

PurposeAlthough unplanned extubation (UE) is a common occurrence in neonatal intensive care units (NICUs), the factors influencing UE have not been clearly identified in South Korea. Therefore, we investigated the incidence of UE along with its risk factors among neonates in the NICU. Design and methodsThis retrospective cohort study was conducted in a single NICU in B city. The electronic medical records of 137 ventilated neonates admitted between January 2017 and June 2018 were analyzed using an audit tool on extubation. Kaplan–Meier estimation and univariate and multivariate Cox proportional hazards models were used for statistical analyses. ResultsThe rate of UE was 32.1%, with an incidence of 6.56 per 100 ventilation days during the 18-month study period. Risk factors for UE were the use of sedatives or analgesics; no re-fixation of the endotracheal tube (ETT); suction frequency; a high nurse–patient ratio; and working night shifts (weekdays 5 p.m. to 8 a.m.), weekends, or holidays. ConclusionsThe rate of UE among neonates was found to be considerably higher than that of other countries. Among the various factors, nursing-related factors were most commonly associated with the risk of UE. Application to practiceVarious prevention strategies, including complete ETT fixation, maintaining ETT placement, a low nurse–patient ratio, and close observation of the ETT may help reduce UE in the NICU.