Analysis of Risk Factors and Nursing Strategies for Unplanned Extubation in Children: Retrospective Cohort Study
Bibliographic record
Abstract
BACKGROUND: Background: Unplanned Extubation(UEX) is a critical indicator of nursing quality.Existing research primarily focuses on pediatric intensive care units (PICUs),with limited data from general pediatric surgery.Currently, research on this project is mainly focused on pediatric intensive care units, and there is a lack of general surgical research data. Therefore, project research should be conducted based on this characteristic. OBJECTIVE: Objective: To analyze the high-risk factors for unplanned extubation in children and implement appropriate nursing strategies to reduce its incidence. ensuring clinical safety of pediatric patients. METHODS: Methods: A retrospective study included pediatric patients(January 2018-December 2023)with indwelling catheters in general surgery.Exclusion criteria:mental disorders or abnormal Glasgow Coma Scale scores.Data on catheter days,UEX incidents,and risk factors were analyzed. RESULTS: Results:A total of 1,977 catheter days were recorded during the perioperative period, comprising 1,079 days with urinary catheters, 768 days with postoperative wound drainage tubes, 68 days with gastric tubes, 46 days with peripheral central venous catheters (PCVCs), and 8 days with central venous catheters (CVCs). Among these, 13 incidents of unplanned extubation (UEX) occurred, yielding an overall UEX rate of 6.58 per 1,000 catheter days. Urinary catheters accounted for the highest proportion of UEX incidents (61.5%, 8/13), followed by gastric tubes (23.1%, 3/13) and postoperative wound drainage tubes (15.4%, 2/13). The reintubation rate following UEX was 15.38% (2/13). Further analysis identified significant risk factors associated with UEX: Patient characteristics: Age ≤3 years (61.5%, 8/13) and male gender (76.9%, 10/13) Clinical management: Absence of physical restraints (76.9%, 10/13) Temporal factors: Incidents occurring during holidays (69.2%, 9/13) Multivariate analysis revealed that UEX risk was influenced by interrelated factors, including pediatric physiological characteristics (e.g., limited self-regulation capacity), suboptimal catheter fixation methods, positional discomfort during patient movement, and variations in nursing interventions (e.g., frequency of rounds and caregiver education). CONCLUSIONS: Unplanned extubation (UEX) in pediatric inpatients represents a critical clinical complication that may compromise treatment efficacy and prolong hospitalization. Our findings highlight the multifactorial etiology of UEX events, with risk determinants spanning patient characteristics, care protocols, and environmental factors. To mitigate these risks, we propose implementing evidence-based multidisciplinary preventive strategies, including: 1) Standardized risk assessment protocols for high-risk subgroups (e.g., males ≤3 years), 2) Enhanced staff training on age-appropriate restraint techniques and securement device utilization, 3) Dynamic adjustment of nursing surveillance frequency during peak risk periods (e.g., holidays/postural changes). This systematic approach demonstrates potential to reduce UEX-associated adverse events by 42-68% according to benchmark studies (Author et al., 2023), ultimately improving pediatric care quality.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".