Counting unplanned extubations: marked variation among neonatologists

Objective:to assess if neonatologists detect and count unplanned extubations (ues) uniformly.study design:an institutional review board-exempted anonymous web-based survey of neonatology attending and fellow members of the aap neonatal-perinatal medicine section was administered. respondents were queried on practices concerning ue; they were then presented with different case scenarios and asked if they would count the event as a ue.results:of the 509 respondents, 61% track ue rates. of those who track ue rates, 53% reported rates of 1–3 per 100 ventilator days. the top two factors perceived as causing ues were endotracheal tube (ett) dislodgement by patient (65%) and failure of ett holding system at attachment to the face (56%). in the various scenarios where ett was urgently removed by staff, only 19 to 62% of respondents counted the event as a ue, including 23% if the ett was removed by the attending. there was consensus on the scenarios representing self-extubation and elective change of the ett.conclusions:there is wide variation in methods for detecting and counting ue events among neonatologists, which precludes comparison of ue rates across institutions. we speculate that a standardized definition and classification of events will enable benchmarking among neonatal intensive care units, which should accelerate collaborative improvement efforts towards reducing ues in neonates.