Prevention Of Endotracheal Unplanned Extubation In Pediatric Hospital:a Clinical Practice Guideline

Background Endotracheal tube is widely used in ICU critically ill patients. Unplanned extubation is a potentially life-threatening event cased by various factors. It is very useful to find out the risk factors assosiated with UEX.To improve patient safety, it’s urgent to put the best evidence of unplanned extubation prevention into clinical practice by developing an evidence-based clinical practice guideline(CPG) on pediatric unplanned extubation prevention.Objective Based on the method of evidence-based medicine, this study aimed at primarily appraising and synthesizing evidence of unplanned extubation on pediatric patients, describing and analyzing the current practice on this regard, and developing a clinical practice guideline.Methods Based on the method of evidence-based medicine, evidence on unplanned extubation in pediatric hospital was appraised and synthesized by a systematic review and a content analysis. A survey and in-depth interviews of key informants were conducted to explore the current practice of unplanned extubation in pediatric hospital. A clinical practice guideline on unplanned extubation prevention in hospital was developed.Results1.Evidence on incidence, risk factors, prevention strategies and post extubation management in hospital was appraised and synthesized by a systematic review of eleven cohort studies and a content analysis of fifteen Chinese articles, which had laid the literature foundation for an evidence-based CPG on unplanned extubation.2.Current practice investigation was done by a survey of two hundred and fourry-seven patients with endotracheal tubes and in-depth interviews of twenty-one doctors and nurses, which showed factors of patients themselves and medical workers can lead to unplanned extubation. So the development of an evidence-based CPG on unplanned extubation prevention should take the status que into consideration.Conclusion1.Evidence-based practice on unplanned extubation prevention is a continuous quality improvement cycle of finding out and bridging gaps between best evidence and current situation, with consideration of clinical situation and professionals’clinical expertise.2.The evidence-based clinical practice guideline(CPG) on pediatric endotracheal unplanned extubation prevention need to be checked in clinical utilization.