Unplanned Extubation Rate Pre and Post Recall of Neonatal Endotracheal Tube Securement Device in a Pediatric Neonatal Intensive Care Unit

Abstract

Background:

Endotracheal tubes (ETT) can be secured in many ways. At our institution, oral ETTs sizes 2.5-4.0mm are primarily secured with neonatal ETT securement devices (NEO-fit device by Cooper Surgical) as part of a standard tube securement process. On 11/15/2022, we were affected by a national recall of our standard tube securement device (TSD) that necessitated changes to our standard tube securement model. We aimed to review unplanned extubation (UE) rate pre and post ETT securement device change in our neonatal intensive care unit (NICU).

Methods:

After the device recall our NICU immediately transitioned 2.5-4.0mm ETT to primary securement with 3M Micropore tape, H style (Figure 1) which was our primary securement method for 4.5mm ETTs unable to be secured with a securement device. In an IRB-approved retrospective review we analyzed UE and ETT tube day data 5 months prior to the ETT securement device recall (7/2022-10/2022) and during the recall when the device was not utilized (11/2022-3/2023).

Results:

When comparing pre and post time periods the UE rate in the NICU decreased significantly (P < 0.01) from 0.37 UE/100 days 5 months prior to the recall, to 0.12/100 days for 5 months during the recall (Figure 2). The NICU experienced 2 UE events (secured with neonatal ETT securement device) in the pre recall period, with 541 ventilator days and 1 UE event (secured with taping method in Figure 1) with 804 ventilator days in the recall period.

Conclusions:

Change from one ETT securement device to another had a statistically significant effect on UE rate in our NICU with ETTs ≤ 4.0mm. It was immensely helpful that the clinical teams were familiar with another securement method to facilitate a smooth and safe transition during a device recall. Further studies must be done to evaluate impact over a longer period of time in this patient population.

Figure 1 displays the H style tape taping method.

Figure 2 details the UE rate pre and post device securement change.