tidbits

useful nuggets of information on ue

 ·     Overall complications of extubation (planned or unplanned).  A nice reminder that extubation is inherently risky because it converts a stable airway that can be mechanically ventilated into a potentially unable airway that may or may not be successfully ventilated (Artime & Hagberg, 2014).

·     Frequency of unplanned extubation in ICU.  This article is the source of our statements that UE occurs in 7.3% of ICUs (da Silva & Fonseca, 2012)

·     Good overall look at the nature and causes of UE.  A review of literature that does a nice job describing the causes and complications (Kiekkas, Aretha, Panteli, Baltopoulos, & Filos, 2013).

·     Frequency of complications of UE.  This article describes relationships between UE and ventilator acquired pneumonia, ICU LOS and hospital LOS (de Lassence et al., 2002).

·     The financial cost of UE.  These two articles provide the background and calculations for our cost estimates (Dasta, McLaughlin, Mody, & Piech, 2005; Needham & Pronovost, 2005).

·     The impact fear of UE has on ICU staff’s ability to provide regular “sedation vacations” which are associated with reductions in ICU LOS and complications.  If the person you’re meeting with seems unaware of these recommendations related to ICU “liberation” I’d skip this.  But if the ability of these ICU guidelines to reduce risk seem important this article may be of use.  THE MOST VALUABLE ELEMENT OF THE ARTICLE IS THE QUOTES THAT COME FROM PHYSICIAN AND NURSING STAFF (Sneyers, Laterre, Perreault, Wouters, & Spinewine, 2014).

·     Current state of securement devices.  This is the article that we most frequently site that compares various types of securement and concludes that there are no great choices (Fisher, Chenelle, Marchese, Kratohvil, & Kacmarek, 2014).

·     Big picture view on what hospitals can do to reduce the risks for UE.  Securement is one element, and the one that we at Securisyn are most focused on.  This article provides a broader approach that focuses on securement AND other preventive measures.  I’D FOCUS ON THE FACT THAT SECUREMENT IS THE MOST “CONCRETE”.  OTHER PREVENTION ELEMENTS ARE HARDER TO QUANTIFY LIKE STAFFING LEVELS, NURSING EXPERIENCE, NURSE/PATIENT RATIOS.  MOST HOSPITALS CAN’T NECESSARILY CONTROL THESE OTHER FACTORS, BUT THEY CAN ASSURE ADEQUATE SECUREMENT (Chao et al., 2017).

 

 

 

Artime, C. A., & Hagberg, C. A. (2014). Tracheal extubation. Respir Care, 59(6), 991-1002; discussion 1002-1005. doi:10.4187/respcare.02926

Chao, C. M., Lai, C. C., Chan, K. S., Cheng, K. C., Ho, C. H., Chen, C. M., & Chou, W. (2017). Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units: A 15-year experience. Medicine (Baltimore), 96(27), e6877. doi:10.1097/MD.0000000000006877

da Silva, P. S., & Fonseca, M. C. (2012). Unplanned endotracheal extubations in the intensive care unit: systematic review, critical appraisal, and evidence-based recommendations. Anesth Analg, 114(5), 1003-1014. doi:10.1213/ANE.0b013e31824b0296

Dasta, J. F., McLaughlin, T. P., Mody, S. H., & Piech, C. T. (2005). Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med, 33(6), 1266-1271. 

de Lassence, A., Alberti, C., Azoulay, E., Le Miere, E., Cheval, C., Vincent, F., . . . Group, O. S. (2002). Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: a prospective multicenter study. Anesthesiology, 97(1), 148-156. 

Fisher, D. F., Chenelle, C. T., Marchese, A. D., Kratohvil, J. P., & Kacmarek, R. M. (2014). Comparison of commercial and noncommercial endotracheal tube-securing devices. Respir Care, 59(9), 1315-1323. doi:10.4187/respcare.02951

Kiekkas, P., Aretha, D., Panteli, E., Baltopoulos, G. I., & Filos, K. S. (2013). Unplanned extubation in critically ill adults: clinical review. Nurs Crit Care, 18(3), 123-134. doi:10.1111/j.1478-5153.2012.00542.x

Needham, D. M., & Pronovost, P. J. (2005). The importance of understanding the costs of critical care and mechanical ventilation. Crit Care Med, 33(6), 1434-1435. 

Sneyers, B., Laterre, P. F., Perreault, M. M., Wouters, D., & Spinewine, A. (2014). Current practices and barriers impairing physicians' and nurses' adherence to analgo-sedation recommendations in the intensive care unit--a national survey. Crit Care, 18(6), 655. doi:10.1186/s13054-014-0655-1