The effect of unplanned extubation (UPE) bundle on extubation incidence in critically ill children In Pediatric Intensif Care Unit (PICU) Central General Hospital of dr. Kariadi Semarang

Umi Yanti Maisaroh; Setyoningsih Setyoningsih; Silvy Andriyani; Yayuk Setyowati; Lilik Eko Sunarto

doi:10.26714/mki.8.1.2025.45-52

The effect of unplanned extubation (UPE) bundle on extubation incidence in critically ill children In Pediatric Intensif Care Unit (PICU) Central General Hospital of dr. Kariadi Semarang

Umi Yanti Maisaroh^(1*), Setyoningsih Setyoningsih⁽²⁾, Silvy Andriyani⁽³⁾, Yayuk Setyowati⁽⁴⁾, Lilik Eko Sunarto⁽⁵⁾

(1) Rumah Sakit Umum Pusat Dr. Kariadi Semarang
(2) Rumah Sakit Umum Pusat Dr. Kariadi Semarang
(3) Rumah Sakit Umum Pusat Dr. Kariadi Semarang
(4) Rumah Sakit Umum Pusat Dr. Kariadi Semarang
(5) Rumah Sakit Umum Pusat Dr. Kariadi Semarang
(*) Corresponding Author

Abstract

The Pediatric Intensive Care Unit (PICU) is a separate unit to handle pediatric patients with medical, surgical, and trauma disorders or life-threatening conditions. Endotracheal intubation is a common invasive procedure in pediatric intensive care. Unplanned extubation occurs when the endotracheal tube is accidentally removed. In January 2022, the Intensive Care Installation (IRIN) determined the occurrence of unplanned extubation (UPE) in selected quality indicators. These results require further study to determine the internal factors that influence the occurrence and effect of implementing a bundle on the occurrence of unplanned extubation (UPE) in the PICU (pediatric intensive care unit). This study was to determine the effect of the unplanned extubation (UPE) bundle on reducing the incidence of extubation in critical pediatric patients in the Pediatric Intensive Care Unit (PICU). The method was a quasi-experimental intervention with control and intervention groups containing the unplanned extubation (UPE) bundle, with a total of 20 samples of control and intervention. Inclusion criteria: patients aged <6 years who had an endotracheal tube (ET) with and without ventilator support (T-piece, Jackson-Reese) who were treated in the PICU of Dr. Kariadi General Hospital, Semarang. Data analysis using univariate, bivariate (chi-square), and multivariate (multiple linear regression) methods. The conclusion is that there was an influence of assessment variables of the Unplanned Extubation (UPE) bundle and internal factors of hypersalivation and psychomotor agitation in the occurrence of Unplanned Extubation (UPE) with a p-value of 0.00<0.05 and a value of f count of 10.193>3.01. Research recommendations can be standard operating procedures in pediatric intensive care to improve the quality of nursing services by reducing the incidence of unplanned extubation (UPE).

Keywords

Bundle; Unplanned Extubation (UPE) incident; PICU (Pediatric Intensive Care Unit)

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References

Adiyanto, B., Jufan, A. Y., & Adiyatma, K. H. (2023). Manajemen Ekstubasi Pada Pasien Dengan Jalan Nafas Sulit Perioperatif. Jurnal Komplikasi Anestesi, 9(2), 67–77. https://doi.org/10.22146/jka.v9i2.8341

Ahmadizadeh, S. N., Mahdavi, S. A., Khanbabaee, G., Saeedi, H., Razavi, S. S., & Hashemi Sabour, N. (2024). Comparison of the Efficacy of Comfort Scale with State Behavioral Scale in Critically Ill Pediatrics Patients Under Mechanical Ventilation for Developing Sedation Protocol and Reducing Ventilator-Associated Pneumonia. Journal of Cellular and Molecular Anesthesia, 9(2), 1–5. https://doi.org/10.5812/jcma-146531

Ahyar, H., Maret, U. S., Andriani, H., Sukmana, D. J., Mada, U. G., Hardani, S.Pd., M. S., Nur Hikmatul Auliya, G. C. B., Helmina Andriani, M. S., Fardani, R. A., Ustiawaty, J., Utami, E. F., Sukmana, D. J., & Istiqomah, R. R. (2020). Buku Metode Penelitian Kualitatif & Kuantitatif (Issue March).

Andrianary, & Antoine. (2019). GAMBARAN KEPUASAN ORANG TUA TERHADAP PELAYANAN KEPERAWATAN DI RUANG PICU RSUP DR.WAHIDIN SUDIROHUSODO Skripsi. 2, 89.

Balit, C. R., LaRosa, J. M., Ong, J. S. M., & Kudchadkar, S. R. (2021). Sedation protocols in the pediatric intensive care unit: fact or fiction? Translational Pediatrics, 10(10), 2814–2824. https://doi.org/10.21037/tp-20-328

C Neves, V., G Ribas, C., Miranda, B., Bitencourt, E., Koliski, A., Cat, M., & Eduardo Carreiro, J. (2020). Effectiveness of a bundle to prevent unplanned extubation in a pediatric intensive care unit: A multidisciplinary approach. Pediatric Dimensions, 5(1), 1–5. https://doi.org/10.15761/pd.1000201

da Silva, P. S. L., & Fonseca, M. C. M. (2020). Factors Associated With Unplanned Extubation in Children: A Case–Control Study. Journal of Intensive Care Medicine, 35(1), 74–81. https://doi.org/10.1177/0885066617731274

Ferreira, J. C. D., Nascimento, M. S., Brandi, S., do Prado, C., Cintra, C. de C., Almeida, J. F., Malheiro, D. T., & Capone, A. (2023). Quality improvement project to reduce unplanned extubations in a paediatric intensive care unit. BMJ Open Quality, 12(1), 1–8. https://doi.org/10.1136/bmjoq-2022-002060

Fitzgerald, R. K., Davis, A. T., & Hanson, S. J. (2015). Multicenter Analysis of the Factors Associated With Unplanned Extubation in the PICU. 217–223. https://doi.org/10.1097/PCC.0000000000000496

Goetz, R. L., Vijaykumar, K., & Solomon, G. M. (2022). Mucus Clearance Strategies in Mechanically Ventilated Patients. Frontiers in Physiology, 13(March), 1–9. https://doi.org/10.3389/fphys.2022.834716

Klugman, D., Melton, K., Maynord, P. O. N., Dawson, A., Madhavan, G., Montgomery, V. L., Nock, M., Lee, A., & Lyren, A. (2020). Assessment of an Unplanned Extubation Bundle to Reduce Unplanned Extubations in Critically Ill Neonates, Infants, and Children. JAMA Pediatrics, 174(6), 1–9. https://doi.org/10.1001/jamapediatrics.2020.0268

Latief, A., Pudjiadi, A. H., Ririe, H. K., & Malisie, F. (2016). Buku Panduan Pelayanan emergensi, rawat intermediet dan rawat intensif anak.

Latief, A. et al. (2016). UKK ERIA. Buku panduan pelayanan emergensi, Rawat Intermediate dan Rawat Intensif Anak. h.1-42.

Mehta, N. M., Sharma, S., & Laussen, P. C. (2015). Unplanned extubation: securing the tool of our trade. Intensive Care Medicine, 41(11), 1983–1985. https://doi.org/10.1007/s00134-015-4000-1

Mekonnen, A., Kebede, Z., & Demissie, D. B. (2023). Incidence, Outcome and Determinants of Unplanned Extubation Among Pediatric Intensive Care Unit Addis Ababa, Ethiopia, 2023: Nested, Unmatched Case-Control Study Design. Pediatric Health, Medicine and Therapeutics, Volume 14, 347–359. https://doi.org/10.2147/phmt.s429457

Melton, K., Ryan, C., Saunders, A., & Zix, J. (2022). Reducing Pediatric Unplanned Extubation Across Multiple ICUs Using Quality Improvement. Pediatrics, 149(5). https://doi.org/10.1542/peds.2021-052259

Ngurah, I. G. (2014). TIVA ( Total Intravenous Anesthesia ). 2(November), 61–72.

Obina, H. L., & Almohileb, H. (2022). Prevention of unplanned extubation in PICU Nurse- led quality improvement project. 1–15.

Patil, A., & Guidelines, R. (2025). Paediatric Intensive Care Unit Endotracheal Tube Management UHL Children ’ s Intensive Care Guideline. September 2022, 1–13.

Razavi, S. S., & Nejad, R. A. (2013). Risk Factors of Unplanned Extubation in Pediatric Intensive Care Unit. 12(3), 11–16.

Silitonga, D. C., Natalia, S., & Silalahi, E. (2021). Penerapan Penggunaan Comfort Scale Di Ruang Intensive Care Unit Di Satu Rumah Sakit Swasta Di Indonesia [Implementation Comfort Scale in Intensive Care Unit At One Private Hospital in Indonesia]. Nursing Current Jurnal Keperawatan, 8(2), 146. https://doi.org/10.19166/nc.v8i2.3100

Siyoto, S. (2015). Dasar Metodologi Penelitian (Cetakan 1,). Literasi Media Publishing.

Sudarma. (2021). Metodologi Penelitian Kesehatan (J. S. Ronal Watrianthos (ed.)). Yayasan Kita Menulis.

Torres, G. M., Do Nascimento, E. R. P., Hermida, P. M. V., de Malfussi, L. B. H., & Galetto, S. G. da S. (2021). Care for unplanned extubation prevention: analysis of the validity of an instrument’s content. Revista Brasileira de Enfermagem, 74(1), 1–10. https://doi.org/10.1590/0034-7167-2018-0998

Tripathi, S., Nunez, D. J., Katyal, C., & Michael Ushay, H. (2015). Plan to have no unplanned: A collaborative, hospital-based quality-improvement project to reduce the rate of unplanned extubations in the pediatric ICU. Respiratory Care, 60(8), 1105–1112. https://doi.org/10.4187/respcare.03984

Wollny, K., Cui, S., McNeil, D., Benzies, K., Parsons, S. J., Sajobi, T., & Metcalfe, A. (2022). Quality improvement interventions to prevent unplanned extubations in pediatric critical care: a systematic review. Systematic Reviews, 11(1), 1–10. https://doi.org/10.1186/s13643-022-02119-8

Wollny, K., Mcneil, D., Moss, S. J., Sajobi, T., Parsons, S. J., Benzies, K., & Metcalfe, A. (2023). Unplanned Extubations Requiring Reintubation in Pediatric Critical Care: An Epidemiological Study. Pediatric Critical Care Medicine, 24(4), 311–321. https://doi.org/10.1097/PCC.0000000000003167