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Published on: July 18, 2025
Factors Associated With Unplanned Extubation in Children: A Case-Control Study
Paulo Sérgio Lucas da Silva1, Marcelo Cunio Machado Fonseca2
1Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil.
Insights
Unplanned extubation (UE) in children is linked to patient agitation, sedation, night shifts, and less experienced nurses. Reintubation risks include low consciousness, secretions, and high oxygenation index (OI).
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Patient Safety
Background:
- Unplanned extubation (UE) is a significant concern in pediatric intensive care units (PICUs).
- Limited case-controlled studies exist on UE determinants and reintubation factors in children.
- Identifying these factors is crucial for improving patient outcomes.
Purpose of the Study:
- To identify risk factors associated with unplanned extubation (UE) in a pediatric intensive care unit (PICU).
- To determine factors contributing to the need for reintubation after UE.
- To analyze outcomes related to UE events in pediatric patients.
Main Methods:
- A case-control study design was employed.
- 94 UE cases were matched with 4 control patients based on age, illness severity, and diagnosis.
- Data on UE events, reintubation, and outcomes were collected and analyzed.
Main Results:
- Patient agitation, continuous sedation, night shifts, less experienced nurses, and high oxygenation index (OI > 5) were significant risk factors for UE.
- Reintubation was associated with lower consciousness (COMFORT score < 27), copious secretions, and high OI (> 5).
- No demographic differences were found between UE cases and controls.
Conclusions:
- Both patient-related and nurse-associated factors contribute to UE in pediatric patients.
- Lower consciousness, abundant secretions, and elevated OI are key risk factors for reintubation post-UE.
- Further research with larger sample sizes is needed to fully elucidate predisposing factors for UE.
Purpose:
Although several studies assess unplanned extubation (UE) in children, few have addressed determinants of UE and factors associated with reintubation in a case-controlled manner. We aimed to identify the risk factors and outcomes associated with UE in a pediatric intensive care unit.
Methods:
Cases of UE were randomly matched with control patients at a ratio of 1:4 for age, severity of illness, and admission diagnosis. For cases and controls, we also collected data associated with UE events, reintubation, and outcomes.
Results:
We analyzed 94 UE patients (0.75 UE per 100 intubation days) and found no differences in demographics between the 2 groups. Logistic regression revealed that patient agitation (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.28-4.65), continuous sedation infusion (OR: 3.27; 95% CI: 1.70-6.29), night shifts (OR: 9.16; 95% CI: 4.25-19.72), in-charge nurse experience <2 years (OR: 2.38; 95% CI: 1.13-4.99), and oxygenation index (OI) >5 (OR: 76.9; 95% CI: 16.79-352.47) were associated with UE. Risk factors for reintubation after UE included prior level of sedation (COMFORT score < 27; OR: 7.93; 95% CI: 2.30-27.29), copious secretion (OR: 11.88; 95% CI: 2.20-64.05), and OI > 5 (OR: 9.32; 95% CI: 2.45-35.48).
Conclusions:
This case-control study showed that both patient- and nurse-associated risk factors were related to UE. Risk factors associated with reintubation included lower levels of consciousness, copious secretions, and higher OI. Further evidence-based studies, including a larger sample size, are warranted to identify predisposing factors in UEs.
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