Incidência e fatores associados à extubação não planejada em uma unidade crítica pediátrica

Abstract

Introduction: Unplanned extubation (UE) in intensive care units is one of the most worrying adverse events, since it is associated with potentially fatal complications, especially in the pediatric population. Incidence and risk factors have been discussed, but more information is still needed in this regard. Objective: To evaluate the incidence for each 100 patient / day intubated and to identify the factors associated with UE in an Intensive Pediatric Unit of reference of University Hospital of Minas Gerais. Methods: Crosssectional and descriptive cohort study, with retrospective and prospective data collection, from July 2016 to June 2018. Patients who presented UE (self-extubation or accidental) were compared to a group with planned extubation in terms of demographic, clinical and ventilatory. The incidence of UE was calculated and the adjusted logistic regression model was performed to determine the risk factors for the event and the outcomes were compared between those with planned and unplanned extubation. Results: A total of 308 patients underwent endotracheal intubation and were included in the analysis. Of these, 20 (6.4%) patients experienced UE, the incidence rate was 1.59 / 100 days of intubation. Patients intubated after procedures of small complexity presented more chances for the occurrence of non-programmed extubation (p <0.0001), with Odds Ratio 61; 95% CI, 15.5-239.8. There was no significant difference between the unplanned and planned extubation groups in terms of mechanical ventilation time, length of stay in the pediatric intensive care unit and mortality. Conclusion: The incidence of UE in the pediatric unit presented a slightly higher value than is currently recommended in the literature and intubation after procedures of small complexity were a risk factor for the occurrence of non-programmed extubation.