Prevention of Accidental Extubation in Neonates
Prevention of Accidental Extubation in Neonates
Prevention of Accidental Extubation in Neonates
Extubation in Newborns
Mark S. Brown, MD
\s=b\ Maintaining endotracheal intuba- ported, although most have not been angle improved the tube's stability. Benzoin
tion is critical to treating respiratory used on asystematic basis.41017 was not routinely applied to the tube in
failure in newborns. To reduce acciden- To decrease accidental extuba¬ either method.
tal extubations in our neonatal intensive The other patient-care practice studied
care unit, a prospective comparison of
tions,18 we devised a prospective study was head restraint. This consisted of a
to compare rates of accidental extu¬
rates of extubation was made between rolled diaper fastened snugly across the
two taping methods and whether or not
bation when two different taping head diagonally from one side of the bed to
a head restraint was used. One tape
methods were used and whether or the other, overlying the side of the face
method was significantly better at pre- not a head restraint was used. In (Fig 2). This was left in place at all times
venting accidental extubations. Head re- addition, the occurrence of certain unless patient care required access to the
straint was not a benefit when used infant activities and nursing and res¬ head or endotracheal tube.
prospectively. Factors that preceded or piratory care procedures before acci¬ Thus, there were four groups of care
were associated with accidental extu- dental extubations were recorded to practices: tape method 1 with or without
bation included the time intubated, in- determine which factors preceded or head restraint and tape method 2 with or
fant agitation, endotracheal tube suc- were associated with accidental extu¬ without head restraint. In addition, infants
tioning, the infant turning its head, chest were stratified by birth weight (<1500 g
bations.
physiotherapy, loose tape, too short a or >1500 g). Care practices were assigned
tube between lip and adapter, weighing, METHODS randomly on admission for each of the two
and endotracheal tube taping. This in- weight groups and continued until inten¬
formation and the study design are All intubated newborns admitted to the tional extubation, death, or 28 days of
valuable in developing strategies to min- newborn center at The Children's Hospital, postnatal age. Oral intubation has been the
imize accidental endotracheal extuba- Denver, from June 1, 1983, through Nov standard of practice since 1978.18 Nasal
tion and the subsequent risks of airway 30, 1983, were entered into the study. The tubes were not changed as part of the
injury and subglottic stenosis in sick study design involved prospective compar¬ study; they were changed only at the at¬
newborns. ison of rates of accidental extubation be¬ tending physician's discretion. Daily
(AJDC 1988;142:1240-1243) tween two different endotracheal tube tap¬ rounds were made by one of six nurses to
ing methods and head restraint, all of which review each infant's bedside chart for medi¬
were currently in use. cations and extubations and to inspect the
Successful management of respira-
tory failure in newborns is the Taping method 1 used two strips of 1-in infant for compliance with the assigned
cornerstone of newborn intensive cloth tape attached to the cheek over care practices.
dried benzoin, each split in a Y up to the A six-month study period was projected
care. Endotracheal intubation is an
corner of the month (Fig 1). The inner leg based on the number of infants who were
integral part of this respiratory ther¬ of each Y was wrapped in a spiral fashion intubated and admitted, the current esti¬
apy, and accidental extubation in a around the tube for at least two wraps, and mated rate of extubation, and an ideal 50%
sick newborn with respiratory failure the remaining leg was attached to the drop in accidental extubations by success¬
can cause rapid deterioration and, of¬ upper or lower lip. Taping method 2 used ful care practice. The rate of extubation
ten, a difficult recovery. Frequent elastic tape cut in an H; one side of the H was expressed as the number of accidental
reintubations may result in airway was applied as a mustache over dried ben¬ extubations per 100 patient-days of intu¬
trauma and subglottic stenosis.1-4 To zoin, and the other side was wrapped in a bation. At two-month intervals the data
reduce accidental extubation, recom¬ spiral fashion around the tube for at least were analyzed. This study was reviewed by
two complete wraps, first one leg, then the the institutional review board.
mendations have been made to mini¬
other (Fig 1). A small tab was folded back Patients were excluded from data analy¬
mize traction on the tube and to se¬ at the end of these halves to facilitate sis if they met any of the following condi¬
curely anchor the endotracheal tube.5-9 removal. A second type of tape, pink tape tions over half the time they were intu¬
A variety of methods of taping or or Hy-Tape (Hy-Tape Surgical Products bated: (1) if the incorrect study protocol
anchoring the tube have been re- Corp, New York), was placed diagonally was being used for either tape method or
from the skin of the zygoma over the elastic head restraint, (2) if they were nasally
Accepted for publication July 10, 1988. tape on the tube, wrapped around once, intubated, (3) if they were paralyzed, or (4)
From the Department of Pediatrics, University and then taken back up to the skin of the if they were sedated.
of Colorado Health Sciences Center, and the
other zygoma. In addition to being water Statistical analysis was by 2 to compare
Department of Perinatology, The Children's Hos-
pital, Denver. resistant, the pink tape does not stretch, rates of extubation, Student's t test to
Reprints not available. and the approach to the tube from a second compare means, and Poisson regression to
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