{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T22:22:10Z","timestamp":1783117330503,"version":"3.54.6"},"reference-count":41,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Respir Dis"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Unplanned extubation (UE) in intensive care units (ICUs) is a significant patient safety concern, associated with increased morbidity and healthcare utilization; the reported rates of UE vary from 1% to 15%. There is sparse data on the effects of multiple performance improvement (PI) strategies to decrease the rate of UE, particularly in inner-city ICU populations. This study evaluates the impact of PI strategies on UE rates and associated patient outcomes in an adult ICU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To determine the impact of performance improvement (PI) strategies on rates of unplanned extubation (UE), reintubation, tracheostomy, mortality, and length of hospital stay in ICU patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective cohort study<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective observational study included 6,397 mechanically ventilated patients admitted to a single tertiary ICU between 2015 and 2023. Three distinct time periods were compared: Period 1 (2015\u20132017, pre-PI), Period 2 (2018\u20132020, early-PI), and Period 3 (2021\u20132023, sustained-PI). Demographics, sedation practices, UE characteristics, and outcomes were analyzed using logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      UE incidence declined significantly from 3.79% in Period 1 to 2.17% in Period 3 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Reintubation rates dropped from 45.2% to 26.7% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011), and tracheostomy rates from 19.0% to 2.2% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Multivariate analysis showed reduced odds of reintubation in Periods 2 (OR\u2009=\u20090.219,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and 3 (OR\u2009=\u20090.345,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021) and reduced odds of tracheostomy in Period 3 (OR\u2009=\u20090.011,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016). Risk factors for reintubation included the absence of prior intubation history and not undergoing spontaneous breathing trials. Older age (\u2a7e71\u2009years) and positive urine toxicology for opiates were strongly associated with tracheostomy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Implementation of PI strategies significantly reduced rates of unplanned extubation, reintubation, and tracheostomy. These findings support continued quality improvement initiatives in ICU airway management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17534666251383662","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T09:04:53Z","timestamp":1760000693000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of performance improvement strategies on unplanned extubation in an inner-city intensive care unit"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3502-9594","authenticated-orcid":false,"given":"Kriti","family":"Gupta","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA"},{"name":"Affiliated With Icahn School of Medicine at Mount Sinai, New York City, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Espinosa","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalini","family":"Penikilapate","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sindhaghatta","family":"Venkatram","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilda","family":"Diaz-Fuentes","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.accpm.2024.101411"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.33940\/med\/2020.3.2"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2022.103219"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2024.0103"},{"key":"e_1_3_4_6_2","first-page":"55","article-title":"Unplanned extubations in intensive care unit: evidence for risk factors. 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