A low-cost educational intervention to reduce unplanned extubation in low-resourced pediatric intensive care units.

Autor: Jayawardena ADL; Children's Minnesota, Department of Otolaryngology, Minneapolis, MN, USA; Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA., Ghersin ZJ; Massachusetts General Hospital, Pediatric Intensive Care Unit, Boston, MA, USA., Guzman LJ; Benjamin Bloom Hospital, Pediatric Intensive Care, San Salvador, El Salvador., Bonilla JA; Benjamin Bloom Hospital, Department of Otolaryngology San Salvador, El Salvador., Abrego S; Benjamin Bloom Hospital, Pediatric Anesthesia, San Salvador, El Salvador., Aguilar A; Benjamin Bloom Hospital, Respiratory Therapy, San Salvador, El Salvador., Ramos D; Benjamin Bloom Hospital, Department of Otolaryngology San Salvador, El Salvador., Zablah E; Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA; The Benjamin Harry Peikin Foundation, Boston, MA, USA., Callans K; Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA; Massachusetts General Hospital for Children, Boston, MA, USA., Macduff M; Massachusetts General Hospital, Department of Respiratory Care Services, Boston, MA, USA., Cayer M; Massachusetts Eye and Ear Infirmary, Department of Anesthesia, Boston, MA, USA., Gallagher TQ; Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Department of Otolaryngology-Head and Neck Surgery, Pediatric Otolaryngology, 601 Children's Lane, 2nd Floor, Norfolk, VA, 23507, USA., Vangel MG; Massachusetts General Hospital, Department of Radiology, Boston, MA, USA., Peikin MH; The Benjamin Harry Peikin Foundation, Boston, MA, USA., Yager PH; Massachusetts General Hospital, Pediatric Intensive Care Unit, Boston, MA, USA., Hartnick CJ; Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA. Electronic address: christopher_hartnick@meei.harvard.edu.
Jazyk: angličtina
Zdroj: International journal of pediatric otorhinolaryngology [Int J Pediatr Otorhinolaryngol] 2021 Oct; Vol. 149, pp. 110857. Date of Electronic Publication: 2021 Jul 28.
DOI: 10.1016/j.ijporl.2021.110857
Abstrakt: Introduction: Unplanned extubation (UE) is orders of magnitude worse in low-income Pediatric Intensive Care Units (PICUs) than their high-income counterparts. Furthermore, a significant percent (20 %) of UEs result in a destabilizing event or cardiac collapse that negatively contributes to morbidity and mortality. As the principles of safe airway management are universal, we hypothesize that a multi-disciplinary educational intervention bundle which included provision of low-cost cuffed endotracheal tubes (ETT) and ETT tape will decrease the rate of unplanned extubation (UE) in a low-resourced PICU.
Methods: This is a pre-post interventional study powered to evaluate UE of intubated pediatric patients in an El Salvadorian PICU after a multi-disciplinary educational effort and provision of low-cost disposable materials. A multidisciplinary (otolaryngologists, intensivists, anesthesiologists, respiratory therapists, and nurses) educational curriculum involving hands on training, online video modules readily available via bedside QR codes, and pre- and post-testing was administered. The cost of the intervention materials was $1.32 per child. PICU mortality was evaluated as an exploratory outcome.
Results: Nine-hundred and fifty-seven (859 pre-intervention and 98 post-intervention) patients met inclusion criteria. Patients with one or more UEs decreased significantly from 29.4 % to 17.3 % post-intervention (p = 0.01; CI: 0.28-0.88) with an odds ratio of 0.51. The use of a cuffed ETT increased from 12 % to 36 % (p < 0.001; CI: 0.17-0.44; OR:3.74) and cuffed ETT use was associated with a reduction in UE with an odds ratio of 0.40 (p < 0.001; CI: 0.24-0.66). Finally, there was a 4.3 % decrease in pediatric mortality from 26.7 % to 22.4 % that equates to a number needed to treat to prevent a single child mortality of 23. Therefore, the ICER per mortality prevented is $30.7 and the ICER per Disability Adjusted Life Year (DALY) is $0.44.
Conclusion: This multi-faceted intervention bundle is an accessible, scalable, cost-effective means to reduce UE and has implications in reducing global pediatric mortality.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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