Prevalence of extubation and associated risk factors at a tertiary care pediatric intensive care unit

Area of Science:

• Pediatric critical care medicine
• Respiratory physiology
• Clinical outcomes research

Background:

• Extubation failure (EF) in pediatric patients is a significant concern, linked to increased risks of pneumonia, prolonged hospital stays, and mortality.
• Understanding the prevalence and contributing factors of EF is crucial for optimizing mechanical ventilation weaning protocols.

Purpose of the Study:

• To determine the prevalence of extubation failure in pediatric patients.
• To identify the specific factors associated with extubation failure within this population.

Main Methods:

• An observational, retrospective study design was employed.
• Data were collected from pediatric patients (1 month to 18 years) requiring mechanical ventilation >12 hours between 2012-2016.
• Ventilation parameters and causes of extubation failure were recorded for analysis.

Main Results:

• The study included 731 extubated patients, with an EF prevalence of 19.3%.
• The leading causes of EF were upper airway obstruction (51.4%), muscle fatigue (20.1%), respiratory center depression (14.6%), and airway protection inability (9.7%).
• Multivariate analysis identified neurological complex chronic conditions, lower respiratory tract infection with sequelae, acute neurological injury, unplanned extubation, and stridor as independent risk factors for EF.

Conclusions:

• Upper airway obstruction is the primary cause of extubation failure in pediatric patients.
• Neurological sequelae, acute neurological injury, unplanned extubation, and postextubation stridor are significant risk factors associated with extubation failure.