Incidence and risk factors of accidental extubation in a neonatal intensive care unit

Objective: to determine the incidence and risk factors of accidental extubation (ae) in a tertiary neonatal intensive care unit. methods: a prospective cohort study was conducted to determine ae incidence density per 100 patient-days,during a 23-month period,in 222 newborns receiving assisted ventilation (av). logistic regression analysis was used to determine risk factors for ae. the presence of a cyclical pattern in extubation rates,according to the variables of interest,was investigated by cosinor analysis. results: the mean ae rate was 5.34/100 patient-days ventilated. ae-associated predictive variables were: subsequent use of the oral and nasal routes during av [relative risk (rr) = 4.73; 95% confidence interval (95%ci) 1.92-11.60],av duration (per day,rr = 1.03; 95%ci 1.02-1.04),and number of patient-days ventilated (rr = 1.01; 95%ci 1.01-1.02). according to the adjusted multiple regression analysis,total av time was the only independent predictor of ae in this sample (rr = 1.02; 95%ci 1.01-1.03). av time of 10.5 days showed an accuracy of 0.79 (95%ci 0.71-0.87) for the occurrence of ae. cosinor analysis showed significant periodicity in overall ae rate and in the number of patient-days ventilated. there was a significant correlation between the number of patient-days ventilated and ae frequency. conclusion: mean ae density was 5.34/100 patient-days ventilated. av duration was the only independent predictor of ae. the best accuracy for ae occurrence was achieved at 10.5 days of av duration. copyright © 2010 by sociedade brasileira de pediatria.