Practice Variability and Unplanned Extubation Rates across Pediatric Intensive Care Units

Objectives The purpose of this study was to describe the care of intubated patients in pediatric critical care. Acknowledging there are several perceived factors that contribute to unplanned extubations, a secondary objective was to describe how practice variation may relate to observed differences in unplanned extubation rates. Methods A survey about practices related to the care of intubated patients was distributed to all PICUs participating in the Virtual Pediatrics System (VPS, LLC). Unplanned extubation rates for 2019-2020 were obtained from VPS. Univariate and bivariate analyses were performed to describe the responses, with unplanned extubation rates calculated as means. The text responses about perceived causes of unplanned extubation in participants’ sites were explored using thematic content analysis Results A total of 44 PICUs were included in this study (response rate 37.0%). The mean unplanned extubation rate for the sample was 0.41 (95% CI: 0.31 – 0.50) per 100 intubation days. Variability was found across several aspects that impact care, including staffing, the frequency of procedures (e.g. chest radiography), and treatment-related goals (e.g. sedation and mobilization). The perceived causes of unplanned extubations in the sample included patient-, staff-, and equipment-related factors. Conclusions We found practice variability in pediatric critical care units related to the care of intubated patients, which may contribute to the frequency of adverse events. As evidence emerges and professional associations and organizations recommend best practices, knowledge translation will be required for the implementation and de-implementation of practices to improve the quality of care in PICUs.