Counting unplanned extubations: marked variation among neonatologists

Objective: To assess if neonatologists detect and count unplanned extubations (UEs) uniformly. Study Design: An Institutional Review Board-exempted anonymous web-based survey of neonatology attending and fellow members of the AAP Neonatal-Perinatal Medicine section was administered. Respondents were queried on practices concerning UE; they were then presented with different case scenarios and asked if they would count the event as a UE. Results: Of the 509 respondents, 61% track UE rates. Of those who track UE rates, 53% reported rates of 1–3 per 100 ventilator days. The top two factors perceived as causing UEs were endotracheal tube (ETT) dislodgement by patient (65%) and failure of ETT holding system at attachment to the face (56%). In the various scenarios where ETT was urgently removed by staff, only 19 to 62% of respondents counted the event as a UE, including 23% if the ETT was removed by the attending. There was consensus on the scenarios representing self-extubation and elective change of the ETT. Conclusions: There is wide variation in methods for detecting and counting UE events among neonatologists, which precludes comparison of UE rates across institutions. We speculate that a standardized definition and classification of events will enable benchmarking among neonatal intensive care units, which should accelerate collaborative improvement efforts towards reducing UEs in neonates.