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Updated: Jun 30, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Development of a clinical prediction tool for extubation failure in pediatric cardiac intensive care unit
Kwannapas Saengsin1,2, Rekwan Sittiwangkul1, Thirasak Borisuthipandit3
1Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Insights
A new score predicts extubation failure in pediatric cardiac patients. This tool helps guide clinical decisions and improve personalized care for children with heart conditions.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Clinical Prediction Modeling
Background:
- Extubation failure in pediatric patients with heart disease is linked to increased morbidity and mortality.
- Effective prediction of extubation failure is crucial for optimizing patient management and outcomes.
Purpose of the Study:
- To develop and validate a clinical risk score for predicting extubation failure in pediatric cardiac patients.
- To aid in clinical decision-making and management strategies for this vulnerable population.
Main Methods:
- Retrospective study conducted in a Pediatric Cardiac Intensive Care Unit (PCICU).
- Data collected from July 2016 to May 2022.
- Multivariable logistic regression used to identify predictors and develop the risk score, with evaluation of discrimination and calibration.
Main Results:
- The study analyzed 352 extubation events from 270 patients; 11.36% experienced extubation failure.
- Key predictors identified were history of pneumonia, history of re-intubation, and high saturation in physiologic cyanosis.
- The developed Pediatric CMU Extubation Failure Prediction Score (Ped-CMU ExFPS) demonstrated acceptable discrimination (AUC 0.77) and good calibration.
Conclusions:
- The Ped-CMU ExFPS is a reliable tool for predicting extubation failure in pediatric cardiac patients.
- Implementation of this score can support personalized care and improve clinical management.
- Further external validation is recommended prior to widespread clinical adoption.
Introduction/Objective:
Extubation failure in pediatric patients with congenital or acquired heart diseases increases morbidity and mortality. This study aimed to develop a clinical risk score for predicting extubation failure to guide proper clinical decision-making and management.
Methods:
We conducted a retrospective study. This clinical prediction score was developed using data from the Pediatric Cardiac Intensive Care Unit (PCICU) of the Faculty of Medicine, Chiang Mai University, Thailand, from July 2016 to May 2022. Extubation failure was defined as the requirement for re-intubation within 48 h after extubation. Multivariable logistic regression was used for modeling. The score was evaluated in terms of discrimination and calibration.
Results:
A total of 352 extubation events from 270 patients were documented. Among these, 40 events (11.36%) were extubation failure. Factors associated with extubation failure included history of pneumonia (OR: 4.14, 95% CI: 1.83-9.37, p = 0.001), history of re-intubation (OR: 5.99, 95% CI: 2.12-16.98, p = 0.001), and high saturation in physiologic cyanosis (OR: 5.94, 95% CI: 1.87-18.84, p = 0.003). These three factors were utilized to develop the risk score. The score showed acceptable discrimination with an area under the curve (AUC) of 0.77 (95% CI: 0.69-0.86), and good calibration.
Conclusion:
The derived Pediatric CMU Extubation Failure Prediction Score (Ped-CMU ExFPS) could satisfactorily predict extubation failure in pediatric cardiac patients. Employing this score could promote proper personalized care. We suggest conducting further external validation studies before considering implementation in practice.
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