Case-control Study on Risk Factors of Unplanned Extubation Based on Patient Safety Model in Critically Ill Patients with Mechanical Ventilation

PURPOSE: This study aimed to identify risk factors of unplanned extubation in intensive care unit (ICU) patients with mechanical ventilation using a patient safety model. METHODS: This study was designed to be a case-control study. Data collection sheets, including 29 risk factors of unplanned extubation in mechanically ventilation patients were retrospectively collected based on a patient safety model over 3 years. From 41,207 mechanically ventilated patients, 230 patients were identified to have unplanned extubation during their ICU stay. Based on the characteristics of the cohort of 230 patients who had unplanned extubation, 460 case control comparison groups with planned extubation were selected by matching age, gender and diagnosis. RESULTS: Risk factors of unplanned extubation were categorized as people, technologies, tasks, environmental factors and organizational factors, by five components of the patient safety model. The results showed the risk factors of unplanned extubation as admission route [odds ratio (OR) = 1.8], GlasgowComa Scaleemotor (OR = 1.3), Acute Physiology and Chronic Health Evaluation score (OR = 1.06), agitation (OR = 9.0), delirium(OR = 11.6), mode of mechanical ventilation (OR = 3.0–4.1) and night shifts (OR = 6.0). The significant differences were found between the unplanned and the planned extubation groups on the number of reintubation (4.3% vs. 79.6%, p < .001), ICU outcome at the time of discharge (χ² = 50.7, p < .001), and length of stay in the ICU (27.0 ± 33.0 vs. 43.8 ± 43.5) after unplanned extubation. CONCLUSIONS: ICU nurses should be able to recognize the risk factors of unplanned extubation related with the components of the safety model so as to improve patient safety by minimizing the risk for unplanned extubation.

A Longitudinal Study of Calcium and Phosphorus Intakes of Korean Infants from 1 to 3 Months in Breast-Fed vs Formula-Fed Infants / 대한지역사회영양학회지

This study was carried out to evaluate the calcium and phosphorus intakes and correlation with growth performance of 25male breast and formula-fed infants from 1 to 3 months postpartum. There were four groups breast-fed(BF) and three formula-fed groups(FFM, FFN and FFP). There was no significant difference in the height and weight of infants according to feeding methods and formula brands. Milk intake and the concentration of calcium and phosphorus from human milk and the formulas were measured. The average calcium content of human milk was 26.6+/-4.1mg/dl and 13.5+/-2.0mg/dl, respectively. The average calcium intakes of the brest-fed and formula-fed infants were 205.5+/-29.3mg/day and the 460.5+/-70.6mg/day, respectively the average calcium intake of breast-fed infants was significantly lower than that of formula fed infant. The percent of RDA(41%) of breast-fed infants was lower than that(75.4%) of formula fed infant. The average phosphorus intake of the brest-fed and formula-fed infants were 105.1+/-20.1mg/day and 288.3+/-37.3mg/day, respectively. The precent of RDA(27%) for brest fed was significantly lower than that(75.4%) of formula fed. The Ca/P ratios were 2.1 in brest fed and 1.6 in formula fed infant. The average calcium and phosphorus intakes of the formula fed infants was higher than that of the brest-fed infants. This data suggests the calcium and phosphorus intakes form human milk sufficiently support the growth of infants. Therefore, the level of calcium and phosphorus recommended dietary allowances for infants should be reduced.