1186 COMPLICATIONS OF PROLONGED ENDOTRACHEAL INTUBATION (PEI)

Abstract

We prospectively evaluated the complications of PEI in 90 infants (800-5140 g) who were intubated 13,371 hours (1.5 patient years). There were 118 tubes in place an average of 147 hours (38-668). 95 tubes were clear at extubation, 18 thinly coated with mucus but clear, and 5 occluded. 3/5 occluded tubes had a Murphy eye. 3/5 were partially occluded and only discovered at extubation. All occluded tubes were from infants weighing >2100 g. Bronchial intubation (BI) occured 36 times in 29 patients, 20 immediately after intubation. 50% of BI were in patients <1500 g. 57% of late BI occurred with inadequate taping. Accidental extubation occurred 6 times in 5 infants weighing 1220±480 g. Their activity was normal; 2 had inadequate taping. Endotracheal tubes were changed 21 times in 13 infants after 1.5-461 hours of intubation; 2 for occlusion, 4 for suspected occlusion, 6 for no air leak at 15 cm H2O, 3 for malposition and 6 miscellaneous. On 88 occasions the tube was resutured and taped, 22 due to initial malposition of the tube. Of the remaining 66, 17% were high, 33% low and 50% loose. Retaping and suturing occurred every 8.4 days on average. Slight bleeding occurred with suctioning in 30 patients 7% of the time. No infant had pulmonary hemorrhage. There was no evidence of subglottic stenosis at post or discharge despite 38-1102 hours of intubation. We conclude that 1) tube occlusion usually occurs in large babies, 2) malposition and accidental extubation usually occurs in small babies, 3) the tube complication rate is low, 4) ½ the complications are preventable.

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