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Updated: Aug 18, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Extubation failure in pediatric intensive care incidence and outcomes
Steven D Baisch1, William B Wheeler, Stephen C Kurachek
1Division of Pediatric Critical Care Medicine, Children's Hospitals and Clinics, Minneapolis and St. Paul, MN, USA.
Insights
Failed extubation in children leads to longer hospital stays and more mechanical ventilation. However, reintubation does not increase the risk of death in pediatric intensive care unit patients.
Area of Science:
- Pediatric critical care medicine
- Respiratory therapy
- Pediatric intensive care unit outcomes
Background:
- Reintubation after extubation in children is a significant clinical event.
- Understanding the outcomes associated with failed extubation is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate if children requiring reintubation face increased risks of prolonged hospitalizations, congenital heart disease, and death.
- To compare outcomes of failed extubation patients with age- and disease-severity-matched controls.
Main Methods:
- Prospective evaluation of children undergoing extubation from 1997-2001.
- Retrospective analysis of all failed extubation cases within a large pediatric intensive care unit.
- Failed extubation defined as unanticipated endotracheal tube replacement within 48 hours.
Main Results:
- 4.1% of pediatric intensive care unit patients (130/3193) failed extubation.
- Failed extubation was associated with longer hospital stays, pediatric intensive care unit stays, mechanical ventilation duration, and tracheostomy placement (p < .001).
- Children with congenital heart disease who failed extubation had the longest hospitalizations (40.0 days).
Conclusions:
- Failed extubation in pediatric intensive care unit patients is linked to extended hospital and ventilator courses.
- Reintubation in this population is not associated with an increased risk of mortality compared to successful extubation.
- Congenital heart disease is a significant factor in prolonged hospitalizations following failed extubation.
Objectives:
To evaluate the hypotheses that children requiring reintubation are at an increased risk of prolonged hospitalizations, congenital heart disease, and death compared with age- and disease-severity-matched control patients.
Design:
Prospective decision to evaluate all children undergoing extubation over a 5-yr time interval (1997-2001) with retrospective analysis of all failed extubation patients.
Setting:
A large multidisciplinary, dual-site, single-system pediatric intensive care unit caring for critically ill and injured children.
Patients:
All children intubated and ventilated during the study period (1997-2001).
Interventions:
None.
Measurements And Main Results:
Failed extubation was defined as the unanticipated requirement to replace an endotracheal tube within 48 hrs of extubation. One hundred thirty children of 3,193 pediatric intensive care unit patients failed extubation (4.1%). The median age of children who failed extubation was 6.5 months, compared with a median age of 21.3 months in the control population. The median age of failed extubation in children with cardiac disease was 9.3 months. Failed extubation patients had lengthier hospital and pediatric intensive care unit stays, longer duration of mechanical ventilation, and a higher rate of tracheostomy placement than nonfailed extubation patients (p < .001). Children with congenital heart disease who failed extubation had the longest duration of hospitalization (40.0 +/- 5.4 days). Conversely, cardiac patients who did not fail extubation had the shortest length of stay (11.2 +/- 0.4 days).
Conclusions:
In the present trial, 4.1% of mechanically ventilated children failed extubation. Pediatric intensive care unit patients with failed extubation have longer hospital, pediatric intensive care unit, and ventilator courses but are not at increased risk of death relative to nonfailed extubation patients.
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