Practice guideline for prevention of unplanned extubation in critically Ill Infant: A systematic review
Keywords:
prevention, unplanned extubation, critically ill infantAbstract
This systematic review aimed to summarize the practice guideline to prevent unplanned extubation in critically ill infant. Twenty-five evidence based nursing practice articles published during 2003-2021 were included in the study. The articles searching strategy included the following key words: “nenonatal intensive care unit,” "unplanned extubation," “risk factor,” and “quality improvement”. An appraisal form and data extraction form for experimental studies developed by Joanna Briggs Institute was used to appraise the studies. The articles included 16 studies in level 2, one study in level 3a, three studies in level 3b, and five studies in level 3c. Regarding the grade of recommendation, 22 studies were classified as level A and three studies were classified as level B. The results showed that the practice guideline were composed of: 1) patient preparation process, including provision of information to relatives about the need for endotracheal intubation, and selection for appropriate size of endotracheal tube; 2) monitoring of risk factors leading to unplanned extubation comprising of patient aspect, including high salivary secretion, a lot of secretion, coughing, agitation, head shaking, restless, or pain from medical procedures/ surgery; nursing staff aspect, including knowledge and awareness in risk factors leading to unplanned extubation; equipment aspect, including wet of fixing plaster and peel off from endotracheal tube, retraction of endotracheal tube, water in airway circuit; technical care aspect, including checking the size and depth of the tube, strapping endotracheal tube, positioning patients, giving sedative agents, restraining of wrist, and wrapping patients; environment aspect, including alarm setting; 3) communication with the medical team in preparation of extubation. It can be concluded that nursing guideline, covering risk factors for unplanned extubation together with the innovative application in preventing unplanned extubation and assessment of the readiness for extubation on a regular basis, help reduce the incidence of unplanned extubation.
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