Prevention of accidental extubation in ventilated infants and children

Objective: The purpose of the study was to evaluate the incidence of accidental extubation (AE) using a designated means of endotracheal tube (ETT) fixation. Design: Data collection for 320 consecutive ventilated infants and children. Setting: A six-bedded multi-disciplinary paediatric intensive care unit in a tertiary hospital. Subjects: Three hundred and twenty consecutive intubated infants and children aged from one day to 17 years. Interventions: The ETT was fixed using one long strip of cloth tape. The tape was wrapped two revolutions around the ETT, then applied to one cheekbone and finally around the head at the maximal contour on to the other cheekbone. Post-intubation and daily chest X-ray were performed. The ETT fixation was replaced daily, using the same technique, or more frequently whenever the tape became too moist. The security and fixation of the ETT were examined every 4 hours. Measurements and results: Of 320 patients, 289 received sedation and/or analgesia and in 108 of these muscle relaxation was added. The average intubation time was 4.7 ± 9.1 (mean ± SD) days with a total of 1504 intubation days. One hundred and sixty-five patients (52%) were intubated orally and 155 patients (48%) were intubated nasally. Two of 320 patients (0.62%) experienced AE, a rate of 0.13/100 intubation days. Mild irritation of the face skin due to tape or replacing of fixation occurred in 25% of patients. No significant skin reactions were observed. Conclusions: The use of cloth tape, with round-the-head taping and strict adherence to routine daily replacement of fixation, decreases the rate of accidental extubation in infants and children.