Analysis of factors influencing unplanned extubation in children and implementation of nursing strategies (Preprint)

BACKGROUND Unplanned extubation (UEX) serves as a crucial indicator for monitoring the quality of nursing care and can result in irreversible harm, impacting both adults and children. In adult Intensive Care Units (ICUs), the incidence of UEX generally ranges from 7% to 18%[23], with endotracheal tube extubation being associated with more severe consequences[24], occurring at a rate of 0.2%-14.6%[25]. For children, literature reports UEX occurrence rates of 1.18%-8.24%[18] and 3.7‰-5.0‰[6], with pediatric ICU rates ranging from 0.43% to 0.79%[1]. The occurrence of unplanned extubation adverse events can impact a child's treatment and surgical outcomes when re-intubation is not immediately feasible, leading to prolonged hospital stays, increased caregiver-patient conflicts, and compromised nursing quality. OBJECTIVE Objective: To analyze the high-risk factors of unplanned extubation in children and implement appropriate nursing strategies to reduce the incidence of adverse events related to unplanned extubation, ensuring clinical safety of pediatric patients. METHODS Methods: A retrospective study was conducted on pediatric patients who underwent surgery in general pediatrics from January 2018 to December 2023 and experienced unplanned extubation during hospitalization, excluding cases caused by mental illness. RESULTS Results: During the perioperative period, a total of 1977 days of intubation were recorded, including 1079 days with urinary catheters, 68 days with gastric tubes, 768 days with postoperative wound drainage tubes, 46 days with peripheral central venous catheters, and 8 days with CVCs. There were 13 instances of unplanned extubation, comprising 8 urinary catheters, 3 gastric tubes, and 2 postoperative wound drainage tubes. The rate of unplanned extubation was 6.58‰, and the re-intubation rate was 15.38%. CONCLUSIONS . The study indicates that unplanned extubation is associated with factors such as the child's own conditions, changes in body position comfort, methods of catheter fixation, timing and date of extubation, and the extent of nurse rounds and education. Therefore, enhancing nurses' awareness of risk prevention and adopting effective restraint measures, adjusting the frequency of adhesive fixation, and improving fixing equipment are key to reducing the risk of unplanned extubation in general pediatrics. Effective nursing strategies significantly lower the risk of unplanned extubatio