Flexible bronchoscopic findings and the relationship to repeated extubation failure in critical children

Extubation failure (EF) in acute pediatric cases causes high morbidity and prolonged hospitalization, some of which might encounter EF repeatedly. This study aims to investigate flexible bronchoscopic findings of airway problems associated with repeated EF (REF) in children.

We retrospectively reviewed the medical records of intubated children from 2005 to 2013 and enrolled those with EF (reintubated within 48 h after extubation) and receiving flexible bronchoscopy (FB) examinations. We divided all subjects into two groups, the REF group (reintubated within 48 h after FB examination) and control group (no need of reintubation), and compared the related clinical conditions and outcomes.

We assessed 30 children (REF group, 17 cases; control group, 13 cases). Among them, no significant difference was observed in age, weight, and underlying diseases. In the REF group, the outpatient ratio, tracheostomy rate, intubation days, respiratory or oxygen supported days, and EF episodes were significantly higher than the control group (p < 0.05). Moreover, the FB findings in the REF group exhibited higher ratios of all airway problems and significantly in the presence of upper airway granulations (odds ratio [OR], 17.9, 95% confidence interval [CI]: 2.7-116.9) and subglottic stenosis (OR, 5.4; 95% CI: 1.1-26.0). After discharge, subjects of the REF group required higher medications than those in the control group (OR, 81.0; 95% CI: 3.9-1655.8).

Upper airway granulations or stenosis significantly augment the risk of REF in children; however, these could be diagnosed early by FB, guiding the therapeutic protocol in acute cases. Thus, anatomical problems of upper airways should be considered in intubated children with EF, and FB is a useful tool for the early diagnosis and management.