Appendix 1

Survey questionnaire

Section 1: Demographics

1. Role in the NICU [] Attending [] Fellow

2. NICU level [] II [] III [] IV

3. Does your primary Hospital have a (check all that apply)?

[] Ob/delivery service [] Neonatal transport team [] Unsure

Section 2: How do you track Unplanned Extubations (UEs)?

1. Do you believe we should track UE events?

[] Yes [] No [] Unsure

2. Does your NICU currently have a system in place to track UEs?

[] Yes [] No [] Unsure

2a. If yes, what is your unit’s typical UE rate per 100 ventilator days?

[] <1 [] 1-3 [] 3.1-5 [] >5 [] Unsure

2b. If yes, what is the primary data source for counting UE events?

[] EMR [] Web-based incident reporting system [] Paper-based UE report

[] Other

3. Which of the following methods/devices does your NICU use routinely to secure ETTs? (Choose as many as apply)

[] Tape [] Neobar® [] Neo-Fit® [] other (please describe)

4. In your experience, choose the two most common factors that contribute to unplanned extubations in your NICU?

[] Failure of ETT holding system at attachment to face

[] Failure of ETT holding system at attachment to ETT

[] ETT dislodged by patient (e.g., agitation)

[] ETT dislodged by staff or family-initiated care or procedures

[] ETT not necessarily dislodged, but pulled by staff due to patient decompensation

[] Other: (specify)

5. Please provide your Center’s operational definition of an unplanned extubation?

[] Yes

Definition………………
[] Do not have one [] Unsure

Section 3: Clinical Vignettes

Which of the following extubation scenarios do you now consider as unplanned?

[] Yes [] No 1. Endotracheal tube (ETT) obviously dislodged with tip visible outside of mouth

[] Yes [] No 2. ETT not obviously dislodged but removed due to poor aeration, no chest rise despite adequate PPV, and/or no color change on CO2 detector

[] Yes [] No 3. ETT removed by caregiver due to acute decompensation of patient without other evidence that ETT was malposition

[] Yes [] No 4. ETT removed due to decompensation during surfactant administration

[] Yes [] No 5. ETT moved inadvertently during tube securement, necessitating replacement

[] Yes [] No 6. ETT changed electively due to large, persistent air leak

Section 4: In your opinion, should an UE event be counted if:

1. The UE occurs under your care, at a location outside the NICU (check all that should be counted)

[] Delivery room [] Operating room [] On transport [] Unsure

2. The baby remains extubated

[] Count UE [] Do not count UE [] Unsure

3. If the ETT was urgently removed by the attending physician due to acute decompensation, should this be counted as an UE?

[] Yes [] No [] Unsure

Other Comments

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Thank you for your valuable input. If you are interested in obtaining preliminary results from this survey, please email