Outcomes, Resource Use, and Financial Costs of Unplanned Extubations in Preterm Infants
- 6 May 2020
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 145 (6)
- https://doi.org/10.1542/peds.2019-2819
Abstract
OBJECTIVES: Unplanned extubations (UEs) in adult and pediatric populations are associated with poor clinical outcomes and increased costs. In-hospital outcomes and costs of UE in the NICU are not reported. Our objective was to determine the association of UE with clinical outcomes and costs in very-low-birth-weight infants. METHODS: We performed a retrospective matched cohort study in our level 4 NICU from 2014 to 2016. Very-low-birth-weight infants without congenital anomalies admitted by 72 hours of age, who received mechanical ventilation (MV), were included. Cases (+UE) were matched 1:1 with controls (−UE) on the basis of having an equivalent MV duration at the time of UE in the case, gestational age, and Clinical Risk Index for Babies score. We compared MV days after UE in cases or the equivalent date in controls (postmatching MV), in-hospital morbidities, and hospital costs between the matched pairs using raw and adjusted analyses. RESULTS: Of 345 infants who met inclusion criteria, 58 had ≥1 UE, and 56 out of 58 (97%) were matched with appropriate controls. Postmatching MV was longer in cases than controls (median: 12.5 days; interquartile range [IQR]: 7 to 25.8 vs median 6 days; IQR: 2 to 12.3; adjusted odds ratio: 4.3; 95% confidence interval: 1.9–9.5). Inflation-adjusted total hospital costs were higher in cases (median difference: $49 587; IQR: −15 063 to 119 826; adjusted odds ratio: 3.8; 95% confidence interval: 1.6–8.9). CONCLUSIONS: UEs in preterm infants are associated with worse outcomes and increased hospital costs. Improvements in UE rates in NICUs may improve clinical outcomes and lower hospital costs.Keywords
This publication has 28 references indexed in Scilit:
- Reducing Unplanned Extubations in the NICUPEDIATRICS, 2014
- Definitions of extubation success in very premature infants: a systematic reviewArchives of Disease in Childhood: Fetal & Neonatal, 2013
- Risk factors and outcome after unplanned extubations on the ICU, a case-control studyCritical Care, 2011
- Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity‐score matched samplesStatistics in Medicine, 2009
- Opioids for neonates receiving mechanical ventilation: a systematic review and meta-analysisArchives of Disease in Childhood: Fetal & Neonatal, 2009
- Adverse Events in the Neonatal Intensive Care Unit: Development, Testing, and Findings of an NICU-Focused Trigger Tool to Identify Harm in North American NICUsPEDIATRICS, 2006
- The Drive to SurviveSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2005
- Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unitPublished by Wiley ,2003
- Validating recommendations for coronary angiography following acute myocardial infarction in the elderlyJournal of Clinical Epidemiology, 2001
- Effect of Unplanned Extubation on Outcome of Mechanical VentilationAmerican Journal of Respiratory and Critical Care Medicine, 2000