Extubação não planejada em pediatria: epidemiologia e estratégias para prevenção

Abstract

Mechanical ventilation through endotracheal tube is a common and safe practice for the assessment of critically ill patients in the Pediatric Intensive Care Unit (PICU), however, it is susceptible to complications, of which unplanned extubation (UE) is the most common. In recent years, UE rates have varied widely, and the current reference target is less than one day per 100 days of hospitalization. The most cited risk factors in literature include ineffective limb mobilization, patients under one year of age, inadequate sedation level, mental status of the patient prior to extubation, orotracheal tube obstruction and fixation technique of the tube. UE can lead to fatal complications, in addition to exposing the patient to morbidity and mortality. Initiatives to reduce UE have been the focus for improving safety indicators of potentially critical pediatric patients. Key prevention strategies identified in literature include: sedation assessment proposals, care team training improvement programs, standardization of procedures. Despite advances in prevention and improvement programs, UE is still a frequent event. Considering all the complications associated with UE, it is assumed to be relevant that pediatric units establish their incidence, know the associated risk factors and adopt preventive measures