Endoscopic management of pediatric extubation failure in the intensive care unit

Area of Science:

• Pediatric critical care medicine
• Otolaryngology
• Pediatric pulmonology

Background:

• Pediatric extubation failure (EF) presents a significant challenge in intensive care settings.
• Identifying the endoscopic findings and prognostic factors for EF is crucial for optimizing patient care.

Purpose of the Study:

• To investigate the endoscopic findings associated with pediatric extubation failure (EF).
• To evaluate the prognosis of endoscopic procedures in children experiencing EF.

Main Methods:

• Retrospective review of pediatric intensive care unit data from January 1, 2013, to December 31, 2019.
• Inclusion of 51 children who underwent endoscopic examination for EF.
• Definition of EF as the need for reintubation within 72 hours of the first extubation attempt.

Main Results:

• Successful extubation after endoscopic procedures in 65% of cases (33/51).
• Common findings included subglottic stenosis (35%) and laryngeal/tracheal granulation (33%).
• Higher transfer rates from other hospitals with prior intubation were observed in the extubation failure group (56% vs 12%).
• Successful extubation rates were 83% for subglottic stenosis and 82% for granulation.
• Neuromuscular and metabolic disorders were identified in two patients in the failure group.
• Laryngomalacia and tracheomalacia cases required temporary tracheostomy after supraglottoplasty.

Conclusions:

• Granulation and subglottic stenosis are primary causes of pediatric extubation failure.
• Endoscopic procedures offer a positive prognosis for many EF cases, particularly those involving granulation or subglottic stenosis.
• Children transferred from other hospitals with existing intubation may face poorer prognoses.
• Undiagnosed neuromuscular and metabolic disorders can contribute to persistent extubation failure.