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Published on: January 17, 2011
Unplanned Extubation During Pediatric Cardiac Intensive Care: U.S. Multicenter Registry Study of Prevalence and
Tanya Perry1, Darren Klugman2, Kurt Schumacher3
1Department of Pediatrics, University of Cincinnati College of Medicine, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Unplanned extubations (UEs) in pediatric cardiac intensive care units (CICUs) are linked to increased risks of cardiac arrest, ventilator-associated pneumonia, and mechanical circulatory support. Factors contributing to UEs differ between medical and surgical patients, suggesting targeted interventions may be possible.
Area of Science:
- Pediatric critical care medicine
- Cardiology
- Epidemiology
Background:
- Unplanned extubation (UE) is a significant concern in pediatric cardiac intensive care units (CICUs).
- Understanding the epidemiology and risk factors for UE is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence of unplanned extubations (UEs) in pediatric cardiac intensive care units (CICUs).
- To identify factors associated with UEs and their impact on adverse outcomes in this population.
Main Methods:
- Analysis of registry data from August 2014 to October 2020.
- Inclusion of patients receiving mechanical ventilation (MV) via endotracheal tube (ETT) across 45 Pediatric Cardiac Critical Care Consortium hospitals.
- Multivariable logistic regression to identify independent predictors of UE.
Main Results:
- A crude UE rate of 2.8% was observed in 56,508 mechanical ventilation courses.
- UE was associated with a higher reintubation rate (26.8% vs. 4.8%) and increased odds of cardiac arrest, ventilator-associated pneumonia (VAP), and mechanical circulatory support (MCS).
- Factors like younger age, airway anomaly, and longer MV duration were associated with UE, with differences noted between surgical and medical cardiac patients.
Conclusions:
- Unplanned extubation in CICU patients is associated with significantly higher odds of adverse events including cardiac arrest, VAP, and MCS.
- Distinct risk factors for UE exist in pediatric cardiac surgical versus medical patients.
- Further research into modifiable factors may lead to targeted strategies to reduce UE incidence and associated complications.
Objectives:
The epidemiology of unplanned extubations (UEs) and associated adverse outcomes in pediatric cardiac ICUs (CICU).
Design:
Registry data (August 2014 to October 2020).
Setting:
Forty-five Pediatric Cardiac Critical Care Consortium hospitals.
Patients:
Patients receiving mechanical ventilation (MV) via endotracheal tube (ETT).
Interventions:
None.
Measurements And Main Results:
Fifty-six thousand five hundred eight MV courses occurred in 36,696 patients, with a crude UE rate of 2.8%. In cardiac surgical patients, UE was associated with longer duration of MV, but we failed to find such association in medical patients. In both cohorts, UE was associated with younger age, being underweight, and airway anomaly. In multivariable logistic regression, airway anomaly was associated with UE in all patients. Younger age, higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score category, longer duration of MV, and initial oral rather than nasal ETT are associated with UE in the surgical group, but we failed to find such associations in the medical group. UE was associated with a higher reintubation rate compared with elective extubation (26.8 vs 4.8%; odds ratio [OR], 7.35; 95% CI, 6.44-8.39; p < 0.0001) within 1 day of event. After excluding patients having redirection of care, UE was associated with at least three-fold greater odds for each of ventilator-associated pneumonia (VAP), cardiac arrest, and use of mechanical circulatory support (MCS). However, we failed to identify an association between UE and greater odds of mortality (1.2 vs 0.8%; OR, 1.48; 95% CI, 0.86-2.54; p = 0.15), but uncertainty remains.
Conclusions:
UE in CICU patients is associated with greater odds of cardiac arrest, VAP, and MCS. Cardiac medical and surgical patients in the CICU appear to have different explanatory factors associated with UE, and perhaps these may be modifiable and tested in future collaborative population research.
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