Unplanned Extubations: Adverse Events in Pediatric Critical Care

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dc.contributor.advisorMetcalfe, Amy
dc.contributor.advisorMcNeil, Deborah
dc.contributor.authorWollny, Krista
dc.contributor.committeememberSajobi, Tolulope
dc.contributor.committeememberBenzies, Karen
dc.contributor.committeememberParsons, Simon J
dc.dateSpring Convocation
dc.date.accessioned2023-05-11T05:26:29Z
dc.date.embargolift2024-04-19
dc.date.issued2022-04-19
dc.description.abstractUnplanned extubations are the uncontrolled and accidental removal of an endotracheal tube and are an adverse event and quality indicator in pediatric intensive care units (PICUs). The literature on quality improvement (QI) interventions to prevent unplanned intubations in PICUs has not been comprehensively synthesized. Furthermore, large-scale studies of practices related to intubation and preventing unplanned extubations have not been conducted across multiple PICUs. Unplanned extubations are infrequent events, with recent studies reporting rates between 0.74-1.5 events/100 intubation days. This has contributed to small sample sizes in previous studies. Small sample sizes and single-centre studies limit the generalizability of findings and the ability to detect associations. These gaps are addressed in this dissertation. The overarching aim of this dissertation was to explore unplanned extubations in PICUs, applying theories and methodology from quality improvement, implementation science, knowledge translation, and epidemiology. In the first manuscript, we conducted a systematic review on quality improvement interventions to prevent unplanned extubations in PICUs. The median number of QI interventions described by the ten included studies was 4.5 [IQR 4-5], with a focus on guidelines, environmental restructuring, education, training, and communication. The second manuscript is an observational, cross-sectional study exploring care practices related to intubation and preventing unplanned extubations across PICUs. Data were gathered via a survey distributed to PICUs in the Virtual Pediatric Systems (VPS) database, and the analyses demonstrated substantial variability in clinical practice, including staffing, frequency of procedures, and treatment-related goals. The third manuscript is a retrospective observational study and prediction model that explored unplanned extubations requiring reintubation in PICUs using data from the VPS database. Of the 5,703 patients that experienced an unplanned extubation, 1,661 (29.1%) required reintubation. Variables associated with increased risk of reintubation were younger age and respiratory diagnosis. The multilevel least absolute shrinkage selection operator (LASSO) logistic regression model predicting reintubation resulted in an AUROC of 0.59 (95% CI: 0.57–0.61) with variables age, weight, diagnosis, and scheduled admission. The results of these three manuscripts contribute to the field of patient safety in PICUs, which is integrated into clinical recommendations and directions for future research.
dc.identifier.citationWollny, K. (2022). Unplanned Extubations: Adverse Events in Pediatric Critical Care (Doctoral thesis). University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca .
dc.identifier.urihttp://hdl.handle.net/1880/116416
dc.identifier.urihttps://dx.doi.org/10.11575/PRISM/dspace/41260
dc.language.isoEnglish
dc.publisher.facultyCumming School of Medicine
dc.subjectCritical Care
dc.subjectPediatrics
dc.subjectEpidemiology
dc.subjectSystematic Review
dc.subject.classificationHealth Sciences--Epidemiology
dc.subject.classificationHealth Sciences--Medicine and Surgery
dc.titleUnplanned Extubations: Adverse Events in Pediatric Critical Care
dc.typedoctoral thesis
thesis.degree.disciplineMedicine – Community Health Sciences
thesis.degree.grantorUniversity of Calgary
thesis.degree.nameDoctor of Philosophy (PhD)
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