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Updated: Sep 5, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Risk factors and outcomes of extubation failure in a South African tertiary paediatric intensive care unit
M-C F Kilba1,2, S Salie1,3, B M Morrow1,3
1Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Insights
Extubation failure in South African children occurred in 11.4% of cases, linked to longer hospital stays and higher mortality. Key risk factors include cardiac admissions, dysmorphology, prematurity, and prolonged ventilation.
Area of Science:
- Critical Care Medicine
- Pediatric Pulmonology
- Epidemiology
Background:
- Extubation failure in mechanically ventilated children is a significant concern with poor outcomes.
- Prevalence and risk factors for extubation failure in South African (SA) children remain understudied.
Purpose of the Study:
- To determine the prevalence of extubation failure in a SA pediatric intensive care unit (PICU).
- To identify risk factors associated with extubation failure in this population.
- To analyze the outcomes of extubation failure in SA children.
Main Methods:
- Prospective, observational study conducted in a tertiary PICU in Cape Town, SA.
- Included all mechanically ventilated children admitted during the study period.
- Extubation failure defined as re-intubation within 48 hours of planned extubation.
Main Results:
- The prevalence of extubation failure was 11.4% (95% CI 7.2% - 16.9%) among 184 planned extubations.
- Risk factors identified include emergency cardiac admissions (aOR 7.58), dysmorphology (aOR 4.90), prematurity (aOR 4.39), and ventilation for ≥48 hours (aOR 6.42).
- Extubation failure was associated with significantly longer ventilation duration, PICU stay, hospital length of stay, and higher 30-day mortality (28.6% vs. 6.7%).
Conclusions:
- Extubation failure in SA children is linked to substantial morbidity and mortality.
- Identified risk factors are consistent with those reported globally.
- Findings provide a basis for targeted interventions to reduce extubation failure rates and improve outcomes in the local context.
Background:
Extubation failure contributes to poor outcome of mechanically ventilated children, yet the prevalence and risk factors have been poorly studied in South African (SA) children.
Objectives:
To determine the prevalence, risk factors and outcomes of extubation failure in an SA paediatric intensive care unit (PICU).
Methods:
This was a prospective, observational study of all mechanically ventilated children admitted to a tertiary PICU in Cape Town, SA. Extubation failure was defined as requiring re-intubation within 48 hours of planned extubation.
Results:
There were 219 episodes of mechanical ventilation in 204 children (median (interquartile range (IQR)) age 8 (1.6 - 44.4) months). Twenty-one of 184 (11.4%) planned extubations (95% confidence interval (CI) 7.2% - 16.9%) failed. Emergency cardiac admissions (adjusted odds ratio (aOR) 7.58 (95% CI 1.90 - 30.29), dysmorphology (aOR 4.90; 95% CI 1.49 - 16.14), prematurity (aOR 4.39; 95% CI 1.24 - 15.57), and ventilation ≥48 hours (aOR 6.42 (95% CI 1.57 - 26.22) were associated with extubation failure. Children who failed extubation had longer durations of ventilation (231 hours (146.0 - 341.0) v. 53 hours (21.7 - 123.0); p<0.0001); longer duration of PICU (15 (9 - 20) days v. 5 (2 - 9) days; p<0.0001) and hospital length of stay (32 (21 - 53) days v. 15 (8 - 27) days; p=0.009); and higher 30-day mortality (28.6% v. 6.7%; p=0.001) than successfully extubated children.
Conclusion:
Extubation failure was associated with significant morbidity and mortality in our setting. Risk factors for extubation failure identified in our context were similar to those reported in other settings.
Contributions Of The Study:
This study provides novel data on the prevalence, risk factors and outcomes associated with extubation failure in a single-centre South African PICU. The results of this study may help identify high-risk groups for extubation failure within our local context, and forms a basis for practice improvement initiatives aimed at decreasing extubation failure rates and improving outcomes.
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