Effectiveness of an Endotracheal Tube Adjustable Stabilizing Set to Prevent Unplanned Extubation in Preterm Infants: A Quasi-experimental Study

Authors

  • Aungsumalin Sangngam Graduate student of Nursing Science Program in Pediatric Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Jutamas Chotibang Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Patcharee Woragidpoonpol Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2024.268079

Keywords:

Adjustable stabilizing set, Endotracheal tube, Neonatal intensive care unit, Oxygen saturation, Preterm infants, Unplanned extubation, Vital signs

Abstract

Preterm infants born before 34 weeks of gestation often face respiratory challenges and may require resuscitation with an endotracheal tube and ventilator support. Unplanned extubation is a common problem for such infants, affecting their care and outcomes. This quasi-experimental study compared the incidence of unplanned extubation, stability of vital signs and oxygen saturation between a control group (n = 24) receiving routine care in a neonatal intensive care unit and an experimental group (n = 24) receiving routine care along with the use of the Endotracheal Tube Adjustable Stabilizing Set, developed by the researchers. The latter set comprises an endotracheal tube-holding cap, head-locked pillows, and an oxygen meter. Data were analyzed using descriptive statistics, t-tests, chi-square tests, and Fisher’s exact tests.

Results show that the control group had an average tracheal tube insertion time of 78.94 hours, while the experimental group had an average of 39.35 hours. The incidence of unplanned extubation was 33.33% (8 cases) in the control group and 4.17% (1 case) in the experimental group. The unplanned extubation rate per 100 ventilator days was 4.41 times in the experimental group, significantly less than in the control group (23.84 times). The experimental group also exhibited significantly more time spent on vital signs and oxygen saturation within normal limits than the control group. In conclusion, using the Endotracheal Tube Adjustable Stabilizing Set in neonatal care can improve patient outcomes by reducing the incidence of unplanned extubation and stabilizing vital signs. This set has passed patentability evaluation for product design and enhances neonatal care by stabilizing endotracheal tubes, reducing slippage, and helping nurses provide more effective care. However, further testing in different settings with larger sample sizes and an equal average tracheal tube insertion time between the two groups is recommended to validate these findings.

References

Muhe LM, McClure EM, Nigussie AK, Mekasha A, Worku B, Worku A, et al. Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross-sectional, observational study. Lancet Glob Health. 2019;7(8):1130-8. doi: 10.1016/S2214-109X(19)30220-7.

Hillman NH, Lam HS. Respiratory disorders in the newborn. In: Wilmott RW, et al., editors. Kendig’s disorders of the respiratory tract in children. Amsterdam: Elsevier; 2019. pp. 338–66. doi: 10.1016/B978-0-323-44887-1.00019-5.

Ge J, Luo C, Lei M, Shi Z, Cheng X, Zhao M, et al. Association between NT-proBNP and prolonged length of stay in hospital among preterm infants born at 28–31 weeks’ gestation. Front Pediatr. 2022;9:783900. doi:10.3389/fped.2021.783900.

Ancel PY, Goffinet F, Kuhn P, Langer B, Matis J, Hernandorena X, et al. Survival and morbidity of preterm children born at 22 through 34 weeks’ gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr. 2015;169(3): 230-8. doi: 10.1001/jamapediatrics.2014.3351.Erratum in: JAMA Pediatr. 2015;169(4):323. doi: 10.1001/jamapediatrics.2015.0528.

Bell EF, Hintz SR, Hansen NI, Bann CM, Wyckoff MH, DeMauro SB, et al. Mortality, in-hospital morbidity, care practices, and 2-year outcomes for extremely preterm infants in the US, 2013–2018. JAMA. 2022;327(3): 248-63. Erratum in: JAMA. 2022;327(21):2151. doi: 10.1001/jama.2022.7723.

Enyew EF, Bitew DA, Gelagay AA. Incidence, time to recovery and predictors among neonates admitted with respiratory distress to the Neonatal Intensive Care Unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021. PLoS One. 2022;17(12): e0278887. doi: 10.1371/journal.pone.0278887.

World Health Organization. Preterm birth [Internet]. Geneva: WHO; 2023 May 10 [cited 2024 Mar 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/newborn-mortality

Fu M, Song W, Yu G, Yu Y, Yang Q. Risk factors for length of NICU stay of newborns: a systematic review. Front Pediatr. 2023;11:1121406. doi:10.3389/fped.2023.1121406.

Litt JS, Halfon N, Msall ME, Russ SA, Hintz SR. Ensuring optimal outcomes for preterm infants after NICU discharge: a life course health development approach to high-risk infant follow-up. Children (Basel). 2024;11(2):146. doi: 10.3390/children11020146.

Tana M, Tirone C, Aurilia C, Lio A, Paladini A, Fattore S, et al. Respiratory management of the preterm infant: supporting evidence-based practice at the bedside. Children (Basel). 2023;10(3):535. doi:10.3390/children10030535.

Lanzillotti Lda, De Seta MH, de Andrade CL, Mendes Junior WV. Adverse events and other incidents in neonatal intensive care units. Cien Saude Colet. 2015;20(3):937–46. doi:10.1590/1413-81232015203.16912013.

Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussain- Alkhateeb L, Lewin A, et al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023;402(10409):1261–71. doi: 10.1016/S0140-6736(23)00878-4.

Department of Health, Ministry of Public Health. Percentage of newborns weighing less than 2,500 grams [Internet]. 2024 [cited 2024 Apr 7]. Available from: https://dashboard.anamai.moph.go.th/dashboard/lbwr/index?year=2023

American Academy of Pediatrics. Pediatric clinical practice guidelines & policies: a compendium of evidence-based research for pediatric practice. Itasca (IL): American Academy of Pediatrics; 2024.

Kaempf JW, Guillen U, Litt JS, Zupancic JA, Kirpalani H. Change in neurodevelopmental outcomes for extremely premature infants over time: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2023;108(5): 458–63. doi:10.1136/archdischild-2022-324457.

da Silva PS, Reis ME, Aguiar VE, Fonseca MC. Unplanned extubation in the neonatal ICU: a systematic review, critical appraisal, and evidence-based recommendations. Respir Care. 2013;58(7):1237-45. doi: 10.4187/respcare.02164.

Morris HF, Schuller L, Archer J, Niesen A, Ellsworth S, Egan J, et al. Decreasing unplanned extubation in the neonatal ICU with a focus on endotracheal tube tip position. Respir Care. 2020;65(11):1648–54. doi:10.4187/respcare.07446.

Peñuelas Ó, Frutos-Vivar F, Esteban A. Unplanned extubation in the ICU: a marker of quality assurance of mechanical ventilation. Crit Care. 2011;15(2):128. doi: 10.1186/cc10049.

de Oliveira PCR, Cabral LA, de Schettino R, Ribeiro SN. Incidence and primary causes of unplanned extubation in a neonatal intensive care unit. Rev Bras Ter Intensiva. 2012; 24(3):230-5. PMID: 23917823.

Cosentino C, Fama M, Foà C, et al. Unplanned extubations in the intensive care unit: evidence for risk factors. a literature review. Acta Biomed. 2017;88(5S):55-65. doi: 10.23750/abm.v88i5-S.6869.

Cho JE, Yeo JH. Risk factors for unplanned extubation in ventilated neonates in South Korea. J Pediatr Nurs. 2022; 62:e54-9. doi: 10.1016/j.pedn.2021.07.004.

Le Blanc G, Jabbour E, Patel S, Kazantseva O, Zeid M, Olivier F, et al. Organizational risk factors and clinical impacts of unplanned extubation in the neonatal intensive care unit. J Pediatr. 2022;249:14-21.e5. doi:10.1016/j.jpeds.2022.06.012.

Powell BM, Gilbert E, Volsko TA. Reducing unplanned extubations in the NICU using lean methodology. Respir Care. 2016;61(12):1567–72. doi: 10.4187/respcare.04540.

Altimier L, Phillips R. The Neonatal Integrative Developmental Care Model: advanced clinical applications of the seven core measures for neuroprotective family-centered developmental care. Newborn Infant Nurs Rev. 2016;16(4):230–44. doi:10.1053/j.nainr.2016.09.030.

Walsh, BK. Neonatal and pediatric respiratory care. 6th ed. Philadelphia: Elsevier; 2023.

Bannasopits N, Chuaykarn U. Benefit of Neosafe innovation for endotracheal tube stabilization on incidence of unplanned extubations in the neonates at Maharaj Nakhon Si Thammarat Hospital. J Nurs SciHealth. 2019;42(4):112-20. Available from: https://he01.tci-thaijo.org/index.php/nah/article/view/184297 (in Thai).

Kritachart P. “Happy Bridge” a new innovation for securing endotracheal tubes in neonate. Sawanpracharak Med J. 2005;2(3):173-84.

Budd RA. The “Logan bow” method for securing endotracheal tubes in neonates. Crit Care Nurse. 1982;2(3):27–8. doi: 10.4037/ccn1982.2.3.27.

K Loganathan P, Nair V, Vine M, Kostecky L, Kowal D, Soraisham A. Quality improvement study on new endotracheal tube securing device (Neobar) in neonates. Indian J Pediatr. 2017;84(1):20–4. doi:10.1007/s12098-016-2231-y.

Benjapornkulnij T. Benefit of the usage of T-model equipment for endotracheal tubes stabilization in neonate. Reg 11 Med J. 2013;7(3):397-404 (in Thai).

Rivas-Fernandez M, Roué I Figuls M, Diez-Izquierdo A, Escribano J, Balaguer A. Infant position in neonates receiving mechanical ventilation. Cochrane Database Syst Rev. 2016; 11(11):CD003668. doi: 10.1002/14651858.cd003668.pub4.

Barbosa RO, Emmanouilidis A, Silva CB, da Silva ALG, Fleig TCM, Cardoso DM. Influence of stress factors on the vital signs of neonates under intensive care. Rev Epidemiol Controle Infecç. 2020;10(1):1-7. doi: 10.17058/.v1i1.13449.

Als H, Duffy FH, McAnulty G, Butler SC, Lightbody L, Kosta S, et al. NIDCAP improves brain function and structure in preterm infants with severe intrauterine growth restriction. J Perinatol. 2012;32(10):797-803. doi: 10.1038/jp.2011.201.

Als H, McAnulty GB. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with Kangaroo Mother Care (KMC): comprehensive care for preterm infants. Curr Womens Health Rev. 2011; 7(3):288-301. doi: 10.2174/157340411796355216.

Aberson CL. Applied power analysis for the behavioral sciences. 2nd ed. New York: Routledge; 2019.

Lenhard W, Lenhard A. Computation of effect sizes. Psychometrica [Internet]. 2022 [cited 2024 Apr 23]. Available from: https://www.psychometrica.de/effect_size.html

Rossi RJ. Applied biostatistics for the health sciences. 2nd ed. Hoboken (NJ): Wiley; 2022.

National Healthcare Safety Network (NHSN), Centers for Disease Control and Prevention. Ventilator-associated event (VAE) [Internet]. 2024 [cited 2024 January 26]. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf

Chomchey A, Sangsawang R. The development of clinical nursing practice guidelines in the prevention of accidental extubation in the Neonatal Intensive Care Unit, Songklanagarind Hospital, Thailand. Adv Practice Nurs. 2017;2:4(Suppl). doi: 10.4172/2573-0347-C1-008.

Phunapai N, Sriromreun P, Sriromreun P, Panburana J, Rearkyai S, Tawkaew S, et al. A novel safety holder device designed for securing the endotracheal tube in neonates with severe respiratory conditions. Inventions. 2024;9(2): 32. doi: 10.3390/inventions9020032.

Downloads

Published

2024-08-31

How to Cite

1.
Sangngam A, Chotibang J, Woragidpoonpol P. Effectiveness of an Endotracheal Tube Adjustable Stabilizing Set to Prevent Unplanned Extubation in Preterm Infants: A Quasi-experimental Study. PRIJNR [Internet]. 2024 Aug. 31 [cited 2024 Nov. 21];28(4):762-77. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/268079