The unresolved problem of accidental ventilation circuit disconnections: let’s not hide behind a finger

BACKGROUND: In the Intensive Care Unit (ICU) setting, healthcare workers often are chellanged by accidental disconnections of the mechanical ventilation (MV) breathing circuits.. The complications that can arise from a circuit disconnection are changes in vital signs and coughing episodes causing discomfort and stress in the patient and potential problems related to the loss of positive end expiratory pressure (PEEP). Among the changes in vital signs (VS) accidental disconnections can cause increased heart rate (HR), blood pressure (BP), respiratory rate (RR), and a reduction of peripheral oxygen saturation (SpO2). The aim of this study was to reveal the rate of accidental disconnections from breathing circuits, identifying the causes, t,the parts of breathing circuits that are interested concerned, ttime of disconnections and the interventions carried out during and after these events. MATERIALS AND METHODS: A prospective observational study was performed on a sample of 72 consecutive patients admitted to the ICU of Careggi University Hospital in Florencefrom November 2018 to February 2019. The disconnection events were recorded on a speficic data sheet. The data sheet is divided into a patient’s information general section, the characteristics of the disconnection events, and a specific section for the recording of VS a. RESULTS: 106 disconnection events were recorded. 48 events (45%) did not cause changes in VS while in the other 58 events (55%) some problems occurred. 87/106 events (82%) were due to maneuvers carried out by healthcare operatorswhile the remaining 19 (18%) were caused by the patients. Among the 87 events caused by operators, 39 events (45%) were generated by nursing inteerventions; in particular mobilization and postural changes caused a total of 19 detachments from breathing circuit (22%). In 31/106 cases (29%), nurses had to perform postdisconnection maneuvers to restore VS. The actions to resolve the disconnection, the post-disconnection interventions and the clinical consequencesresulting from the disconnection events were also recorded. Relevant the section inherent to the vital signs (Figure 1,2,3,4) that sees both the HR and the RR altered after the disconnection as well as the BP and the SpO2 that change substantially to the occurrence of disconnection events. DISCUSSION: These results allowed us to identify the most frequent typologies, times and disconnection points as well as the influence of these events on patients’VS. Although the disconnections from breathing circuits are still considered as low (or not) impact events, they actually exert influence on physiological functions withpossible negative consequences for patients. CONCLUSIONS: Studies on the physiopathological impact of disconnections should be designed and performed in future desirable. The scientific community should be attentive to this typology of events. This study has some limitations, but highlighted many points of improvement of patients’ care, to prevent and limit , accidental disconnection events.