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Incidence and Risk Factors for Cardiovascular Collapse After Unplanned Extubations in the Pediatric ICU
Paulo Sérgio Lucas da Silva1, Marcelo Cunio Machado Fonseca2
1Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil. psls.nat@terra.com.br.
Insights
Cardiovascular collapse is a frequent complication after unplanned extubations (UEs) in pediatric intensive care units (PICUs), especially in infants under 6 months. Preventive strategies may reduce this serious adverse event.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular physiology
- Patient safety
Background:
- Unplanned extubations (UEs) in pediatric intensive care units (PICUs) can lead to life-threatening cardiovascular collapse.
- There is limited pediatric research on the incidence and risk factors of this complication.
Purpose of the Study:
- To assess the incidence, risk factors, and outcomes of cardiovascular collapse following UEs in PICU patients.
- To identify patient characteristics associated with cardiovascular collapse after UEs.
Main Methods:
- Prospective tracking of pediatric patients (1 month to 16 years) who underwent mechanical ventilation for ≥12 hours over 8 years.
- Analysis of patients experiencing UEs, comparing those with cardiovascular collapse (requiring resuscitation or circulatory dysfunction) to those without.
Main Results:
- The incidence of UEs was 0.76 per 100 intubation days, with 19.2% of patients experiencing cardiovascular collapse.
- Younger age (≤6 months), respiratory failure from lower respiratory tract diseases, and poorer pre-extubation oxygenation (lower PaO2/FiO2, higher oxygenation index) were associated with cardiovascular collapse.
- Age ≤6 months was a significant risk factor (odds ratio 3.4, P = .03).
- No significant differences were found in hospital stay, ventilator-associated pneumonia rates, or mortality between groups.
Conclusions:
- Cardiovascular collapse is a significant and frequent complication of UEs in the pediatric ICU, particularly in infants.
- Targeted strategies to prevent UEs in vulnerable pediatric populations may mitigate associated morbidity.
Background:
Cardiovascular collapse is a life-threatening event after unplanned extubations (UEs) in the pediatric ICU (PICU). However, there is a paucity of pediatric studies assessing this complication. We sought to assess the incidence, risk factors, and outcome of cardiovascular collapse after UEs in PICU patients.
Methods:
All children who had been mechanically ventilated for ≥12 h were prospectively tracked for UEs over an 8-y period. Subjects were included in the study if they were between ages 1 month and 16 y and had experienced UE. They were analyzed in 2 groups: those with cardiovascular collapse (defined as the need for cardiopulmonary resuscitation or circulatory dysfunction immediately after UE) and those with no cardiovascular collapse.
Results:
Of the 847 subjects, 109 UEs occurred in 14,293 intubation days (0.76 UEs/100 intubation days), with 21 subjects (19.2%) experiencing cardiovascular collapse, of which 10 required cardiopulmonary resuscitation. Compared with subjects without cardiovascular collapse after UE, children with cardiovascular collapse were younger (<6 months old), with respiratory failure from lower respiratory tract diseases, lower PaO2/FIO2 (218 vs 282 mm Hg), and higher oxygenation indices (5.5 vs 3.5) before UE events. Logistic regression revealed that only an age ≤6 months old was strongly associated with cardiovascular collapse (odds ratio 3.4, P = .03). There were no differences between cardiovascular collapse and non-cardiovascular collapse subjects regarding the length of hospital stay, ventilator-associated pneumonia rate, and mortality.
Conclusions:
Cardiovascular collapse is a frequent complication of UEs, particularly in the youngest children. Specific bundles to prevent UEs may reduce morbidity related to these events.