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Updated: Dec 6, 2025
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Prevalence of Reintubation Within 24 Hours of Extubation in Bronchiolitis: Retrospective Cohort Study Using the
Salar S Badruddin1,2, Jason A Clayton1, Bryan P McKee1,3
1Division of Pediatric Critical Care Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, OH.
Insights
High-flow nasal cannula (HFNC) support after extubation in children with bronchiolitis was associated with a lower reintubation rate compared to noninvasive positive pressure ventilation (NIPPV). Further trials are needed to confirm if HFNC can reduce extubation failure.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Support
- Extubation Outcomes
Background:
- High-flow nasal cannula (HFNC) and noninvasive positive pressure ventilation (NIPPV) are common post-extubation support methods for children.
- Existing evidence comparing extubation failure rates between HFNC and NIPPV is limited in pediatric populations, particularly for bronchiolitis.
Purpose of the Study:
- To investigate the association between post-extubation support modality (HFNC vs. NIPPV) and reintubation rates within 24 hours in pediatric patients with bronchiolitis.
- To test the hypothesis that HFNC is associated with a higher prevalence of reintubation compared to NIPPV in this specific patient group.
Main Methods:
- Secondary analysis of a quality-controlled, multicenter Pediatric Intensive Care Unit (PICU) database (Virtual Pediatric Systems).
- Inclusion criteria: Children under 24 months with primary diagnosis of bronchiolitis, requiring invasive mechanical ventilation.
- Analysis compared reintubation rates within 24 hours between patients extubated to HFNC versus NIPPV, using unmatched and propensity-matched analyses.
Main Results:
- A total of 759 patients were analyzed, with 86.5% receiving HFNC post-extubation.
- The overall 24-hour reintubation rate was 5.9%.
- Extubation to NIPPV was associated with a significantly higher prevalence of reintubation (11.7%) compared to HFNC (5.0%; p=0.016). This association remained significant after adjusting for covariates (OR, 2.43; p=0.027).
Conclusions:
- In children with bronchiolitis, post-extubation support with HFNC was associated with a lower prevalence of reintubation within 24 hours compared to NIPPV.
- The findings suggest that HFNC may be a preferable strategy for post-extubation support in this population.
- Prospective randomized controlled trials are warranted to definitively establish the efficacy of HFNC in mitigating extubation failure.
Objectives:
High-flow nasal cannula and noninvasive positive pressure ventilation are used to support children following liberation from invasive mechanical ventilation. Evidence comparing extubation failure rates between patients randomized to high-flow nasal cannula and noninvasive positive pressure ventilation is available for adult and neonatal patients; however, similar pediatric trials are lacking. In this study, we employed a quality controlled, multicenter PICU database to test the hypothesis that high-flow nasal cannula is associated with higher prevalence of reintubation within 24 hours among patients with bronchiolitis.
Design:
Secondary analysis of a prior study utilizing the Virtual Pediatric Systems database.
Setting:
One-hundred twenty-four participating PICUs.
Patients:
Children less than 24 months old with a primary diagnosis of bronchiolitis who were admitted to one of 124 PICUs between January 2009 and September 2015 and received invasive mechanical ventilation.
Interventions:
None.
Measurements And Main Results:
Among 759 patients, median age was 2.4 months (1.3-5.4 mo), 41.2% were female, 39.7% had greater than or equal to 1 comorbid condition, and 43.7% were Caucasian. Median PICU length of stay was 8.7 days (interquartile range, 5.8-13.7 d) and survival to PICU discharge was 100%. Median duration of intubation was 5.5 days (3.4-9.0 d) prior to initial extubation. High-flow nasal cannula was used following extubation in most (656 [86.5%]) analyzed subjects. The overall prevalence of reintubation within 24 hours was 5.9% (45 children). Extubation to noninvasive positive pressure ventilation was associated with greater prevalence of reintubation than extubation to high-flow nasal cannula (11.7% vs 5.0%; p = 0.016) and, in an a posteriori model that included Pediatric Index of Mortality 2 score and comorbidities, was associated with increased odds of reintubation (odds ratio, 2.43; 1.11-5.34; p = 0.027).
Conclusions:
In this secondary analysis of a multicenter database of children with bronchiolitis, extubation to high-flow nasal cannula was associated with a lower prevalence of reintubation within 24 hours compared with noninvasive positive pressure ventilation in both unmatched and propensity-matched analysis. Prospective trials are needed to determine if post-extubation support modality can mitigate the risk of extubation failure.
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