{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:46:57Z","timestamp":1792108017728,"version":"4.4.0"},"reference-count":23,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"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":["Respir Care"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Unplanned extubation (UE) is defined as unintentional dislodgement of an endotracheal tube (ETT) from the trachea. UEs can lead to instability, cardiac arrest, and may require emergent tracheal re-intubation. As part of our hospital-wide quality improvement (QI) work, a multidisciplinary committee reviewed all UEs to determine contributing factors and evaluation of clinical outcomes to develop QI interventions aimed to minimize UEs. The objective was to investigate occurrence, contributing factors, and clinical outcomes of UEs in the pediatric ICU (PICU), cardiac ICU (CICU), and neonatal ICU (NICU) in a large academic children's hospital. We hypothesized that these would be substantially different across 3 ICUs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>A single-center retrospective review of UEs in the PICU, CICU, and NICU was recorded in a prospective database for the last 5 y. Consensus-based standardized operational definitions were developed to capture contributing factors and adverse events associated with UEs. Data were extracted through electronic medical records by 3 respiratory therapists and local Virtual Pediatric Systems (VPS) database. Consistency of data extraction and classification were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      From January 2016\u2013December 2021, 408 UEs in 339 subjects were reported: PICU 52 (13%), CICU 31 (7%), and NICU 325 (80%). The median (interquartile range) of age and weight was 2.0 (0\u20134.0) months and 5.3 (3.0\u20138.0) kg. Many UE events were not witnessed (54%). Common contributing factors were routine nursing care (no. = 70, 18%), ETT retaping (no. = 62, 16%), and being held (no. = 15, 3.9%). The most common adverse events with UE were desaturation &lt; 80% (33%) and bradycardia (22.8%). Cardiac arrest occurred in 12%. Sixty-seven percent of UEs resulted in re-intubation within 72 h. The proportion of re-intubation across 3 units was significantly different: PICU 62%, CICU 35%, NICU 71%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>UEs occurred commonly in a large academic children's hospital. Whereas UE was associated with adverse events, re-intubation rates within 72 h were &lt; 70% and variable across the units.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.10904","type":"journal-article","created":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T11:27:34Z","timestamp":1701775654000},"page":"184-190","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Outcomes of Unplanned Extubations in a Large Children's Hospital"],"prefix":"10.1177","volume":"69","author":[{"given":"Cheryl L","family":"Dominick","sequence":"first","affiliation":[{"name":"Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke N","family":"Blanke","sequence":"additional","affiliation":[{"name":"Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M","family":"Simmons","sequence":"additional","affiliation":[{"name":"Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle M","family":"Traynor","sequence":"additional","affiliation":[{"name":"Critical Care Center for Evidence and Outcomes, Pediatric Intensive Care Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Fowler","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Professionals, Drexel University, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Nishisaki","sequence":"additional","affiliation":[{"name":"Division of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Napolitano","sequence":"additional","affiliation":[{"name":"Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3181fe472d"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-0902"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001422"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001074"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000406"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2020.0268"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3181b80951"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3334"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-015-4000-1"},{"key":"e_1_3_3_11_2","unstructured":"Virtual Pediatric Systems. Available at: http:\/\/www.myvps.org. Accessed January 22 2023."},{"key":"e_1_3_3_12_2","article-title":"Practice variability and unplanned extubation rates across pediatric intensive care units","author":"Wollny K","year":"2022","unstructured":"Wollny K, , Metcalfe A, , Benzies K, , Parsons S, , Sajobi T, , McNeil D. Practice variability and unplanned extubation rates across pediatric intensive care units. J Pediatr Intensive Care, 2022.","journal-title":"J Pediatr Intensive Care"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2003-0735-L"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/0885066617731274"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002193"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.11124\/JBISRIR-2016-003249"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2016.2535"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003235"},{"issue":"4","key":"e_1_3_3_19_2","first-page":"366","article-title":"Association of nursing workload and unplanned extubations in a pediatric intensive care unit","volume":"8","author":"Ream R","year":"2007","unstructured":"Ream R, , Mackey K, , Leet T, , Green M, , Andreone T, , Loftis L, et al. Association of nursing workload and unplanned extubations in a pediatric intensive care unit. Pediatr Crit Care Med, 2007; 8(4):366\u2013371.","journal-title":"Pediatr Crit Care Med"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-013-2932-x"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000337"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2017.12.017"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000519"},{"key":"e_1_3_3_24_2","unstructured":"Willden H. Best practices: unplanned extubations. American Association for Respiratory Care. 2019. Available at: https:\/\/www.aarc.org\/nn19-unplanned-extubations. Accessed March 30 2023."}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.4187\/respcare.10904","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.10904","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.10904","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T10:53:38Z","timestamp":1775559218000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4187\/respcare.10904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,24]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.4187\/respcare.10904"],"URL":"https:\/\/doi.org\/10.4187\/respcare.10904","relation":{},"ISSN":["0020-1324"],"issn-type":[{"value":"0020-1324","type":"print"}],"subject":[],"published":{"date-parts":[[2024,1,24]]}}}