Evidence map›Paper›PMID 40935403›Full record

ArticleBMJ open quality2025

Impact of adding an airway safety prompt to the A-F bundle on unplanned extubation in the intensive care unit.

Maged Tanios, Huan Mark Nguyen, John W Devlin, Hyunsoon Park, Michael Tanios, Meera Lakshmi Mahidhara, Jay Patel, Sasanapirath Vong, Jeff Cupino, Mark Cordia and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open quality, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Maged TaniosMemorialCare, Long Beach Medical Center, Long Beach, California, USA mtanios@uci.edu.ORCID 0000-0002-4103-6099
Huan Mark NguyenCollege of Pharmacy, Western University of Health Sciences, Pomona, California, USA.
John W DevlinNortheastern University - Boston Campus, Boston, Massachusetts, USA.
Hyunsoon ParkMemorialCare, Long Beach Medical Center, Long Beach, California, USA.
Michael TaniosUniversity of California, Berkeley, Berkeley, California, USA.
Meera Lakshmi MahidharaUniversity of California, Berkeley, Berkeley, California, USA.
Jay PatelMemorialCare, Long Beach Medical Center, Long Beach, California, USA.
Sasanapirath VongMemorialCare, Long Beach Medical Center, Long Beach, California, USA.
Jeff CupinoTibor Rubin VA Medical Center, Long Beach, California, USA.
Mark CordiaSiemens Healthineers AG, Los Angeles, California, USA.
Antonio BeltranMemorialCare, Long Beach Medical Center, Long Beach, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveEndotracheal intubation is a life-saving intervention for adults with acute respiratory failure (ARF) but may result in unplanned extubation (UE). The success of UE prevention efforts has varied. We describe the development, implementation and impact of an airway safety quality improvement programme (ASQIP) embedded in an existing ABCDEF (A-F) bundle on UE occurrence.

designBefore-and-after evaluation of an ASQIP.

setting42-bed mixed intensive care unit (ICU) at a university-affiliated teaching hospital. PATIENTS: Consecutive adult patients, endotracheally intubated for ARF.

interventionThe ASQIP, developed from a literature review, the results of a national clinician survey, local clinician focus group input and root cause analyses of prior UE events, included interprofessional rounding scripts and was embedded into an existing A-F bundle. Multiple implementation strategies were employed, including didactic education to all ICU nurses (registered nurse, RN) and respiratory care therapists (RTs), the daily posting of signs of the ASQIP on the doors of rooms with a patient deemed to be at high risk for UE, and daily reminders from managers to bedside RTs and RNs. MEASUREMENTS: ASQIP implementation was effective and was associated with a significantly lower incidence of UE per 100 MV days (before 0.43 vs after 0.29; p=0.04).

conclusionsA multidisciplinary quality improvement initiative that incorporates airway safety within the A-F bundle may help reduce UE rates in critically ill adults. Future research is needed to validate standardised communication and assess the long-term sustainability of such interventions.

Indexed as

Airway ExtubationAirway ManagementPatient Care BundlesPatient SafetyAdultFemaleFocus GroupsHumansIntensive Care UnitsIntubation, IntratrachealMaleMiddle AgedQuality ImprovementSurveys and QuestionnairesAirway ManagementCritical carePatient safetyQuality improvementTeam training

Identifiers

PMID40935403
PMCPMC12519335

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.