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[Predictors of upper airway obstruction following extubation in critically ill children]
Julia Inés Simonassi1, María Tatiana Canzobre1
1Hospital Nacional de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
Insights
Post-extubation upper airway obstruction affects 25% of children in pediatric intensive care. Infants and those on mechanical ventilation for 3 days or less are at higher risk.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Intensive Care
Background:
- Post-extubation upper airway obstruction is a significant complication in pediatric intensive care.
- It can lead to extubation failure and adverse outcomes in critically ill children.
Purpose of the Study:
- To determine the incidence of post-extubation upper airway obstruction in critically ill children.
- To identify independent risk factors associated with this complication.
Main Methods:
- A prospective, descriptive, observational study was conducted in a pediatric intensive care unit.
- Included were children over 1 month and under 18 years receiving mechanical ventilatory support for over 24 hours.
- Data were collected over two years, including patient demographics, reason for admission, and ventilation parameters.
Main Results:
- The incidence of post-extubation upper airway obstruction was 25% (65 out of 260 patients).
- Independent risk factors identified were age 24 months or younger and mechanical ventilation duration of 3 days or less.
- Extubation failure occurred in 41.5% of affected patients, and 7.7% required tracheostomy.
Conclusions:
- Post-extubation upper airway obstruction is a common occurrence in pediatric intensive care units.
- Younger age (≤ 24 months) and shorter mechanical ventilation duration (≤ 3 days) are significant independent risk factors.
- These findings highlight the need for vigilant monitoring and targeted interventions in at-risk pediatric patients.
Abstract:
Upper airway obstruction after extubation is a serious complication that can lead to extubation fai lure and other unfavorable outcomes in children.
Objective:
to describe the incidence and risk fac tors associated with post-extubation upper airway obstruction in critically ill children.
Patients And Method:
A prospective descriptive observational study was carried out in a pediatric intensive care unit in Argentina over two years. Patients older than 1 month and younger than 18 years, receiving mechanical ventilatory support (MV) for more than 24 hours through an endotracheal tube (ETT) and with at least one programmed extubation were included.
Results:
Of 260 patients, 65 (25%) de veloped post-extubation upper obstruction. Of them, 37 were females (56.9%), with a median age of 14 months and 10 kg weight. The PIM3 score was 2.8 and the most frequent reason for admission was acute lower respiratory infection in 38 (43.1%) patients, among whom 36 (55.4%) had at least one complex chronic condition. Twenty-seven (41.5%) failed extubation and 5 (7.7%) required tracheos tomy. A multiple logistic regression analysis was performed to determine the relationship between different variables with the dependent variable. Independent risk factors explaining post-extubation upper obstruction were age ≤ 24 months and MV support for ≤ 3 days.
Conclusion:
Post-extubation upper airway obstruction is frequent in the pediatric intensive care unit. We found that infants and mechanical ventilation duration less than or equal to 3 days are independent risk factors for its pre sentation.
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