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Updated: Jul 31, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Predictive factors of extubation failure in pediatric cardiac intensive care unit: A single-center retrospective
Kwannapas Saengsin1, Rekwan Sittiwangkul1, Thirasak Borisuthipandit2
1Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Insights
Extubation failure occurred in 11% of pediatric cardiac patients, linked to longer intensive care unit stays. Key predictors include prior pneumonia, stridor, re-intubation history, and palliative surgery.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Cardiovascular Surgery
Background:
- Extubation failure poses significant risks, increasing morbidity and mortality in pediatric cardiac patients.
- This population includes children with congenital or acquired heart conditions, requiring specialized care.
- Identifying predictors of extubation failure is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate factors predicting extubation failure in pediatric cardiac patients.
- To determine the association between extubation failure and clinical outcomes.
Main Methods:
- Retrospective study conducted in a pediatric cardiac intensive care unit (PCICU) from July 2016 to June 2021.
- Extubation failure defined as re-insertion of the endotracheal tube within 48 hours.
- Multivariable log-binomial regression with generalized estimating equations (GEE) analyzed predictive factors.
Main Results:
- 11% of 318 extubation events (from 246 patients) resulted in failure.
- Predictive factors for extubation failure included: history of pneumonia (RR 3.09), post-extubation stridor (RR 2.57), history of re-intubation (RR 2.24), and palliative surgery (RR 1.87).
- Physiologic cyanosis was associated with higher SpO2 in the failure group (P < 0.001).
Conclusions:
- Extubation failure in pediatric cardiac patients is associated with longer PCICU stays but not mortality.
- Careful pre-extubation assessment and post-extubation monitoring are vital for patients with identified risk factors.
- Management of physiologic cyanosis may require balanced circulation through regulated SpO2.
Introduction/Objective:
Extubation failure increases morbidity and mortality in pediatric cardiac patients, a unique population including those with congenital heart disease or acquired heart disease. This study aimed to evaluate the predictive factors of extubation failure in pediatric cardiac patients and to determine the association between extubation failure and clinical outcomes.
Methods:
We conducted a retrospective study in the pediatric cardiac intensive care unit (PCICU) of the Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, from July 2016 to June 2021. Extubation failure was defined as the re-insertion of the endotracheal tube within 48 hours after extubation. Multivariable log-binomial regression with generalized estimating equations (GEE) was performed to explore the predictive factors associated with extubation failure.
Results:
We collected 318 extubation events from 246 patients. Of these, 35 (11%) events were extubation failures. In physiologic cyanosis, the extubation failure group had significantly higher SpO2 than the extubation success group (P < 0.001). The predictive factors associated with extubation failure included a history of pneumonia before extubation (RR 3.09, 95% CI 1.54-6.23, P = 0.002), stridor after extubation (RR 2.57, 95% CI 1.44-4.56, P = 0.001), history of re-intubation (RR 2.24, 95% CI 1.21-4.12, P = 0.009), and palliative surgery (RR 1.87, 95% CI 1.02-3.43, P = 0.043).
Conclusion:
Extubation failure was identified in 11% of extubation attempts in pediatric cardiac patients. The extubation failure was associated with a longer duration of PCICU stay but not with mortality. Patients with a history of pneumonia before extubation, history of re-intubation, post-operative palliative surgery, and post-extubation stridor should receive careful consideration before extubation and close monitoring afterward. Additionally, patients with physiologic cyanosis may require balanced circulation via regulated SpO2.
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