Extubation Failure in the PICU: A Virtual Pediatric Systems Database Study, 2017-2021.

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Therapy
• Mechanical Ventilation Management

Background:

• Extubation failure (EF) in pediatric intensive care units (PICUs) necessitates reintubation, impacting patient outcomes.
• Standardized protocols and noninvasive support aim to optimize liberation from mechanical ventilation (MV).

Purpose of the Study:

• To review extubation failure rates, time to failure, and the utilization of noninvasive respiratory support post-extubation in PICU patients from 2017 to 2021.

Main Methods:

• Retrospective analysis of 111,229 planned extubations in 136 PICUs contributing to the Virtual Pediatric Systems (VPS) database (2017-2021).
• Inclusion criteria focused on patients undergoing planned extubation after mechanical ventilation.

Main Results:

• Overall extubation failure rates (EF48, EF72, EF96) were 4.6%, 5.3%, and 5.8%, respectively.
• Higher EF rates were associated with younger age, genetic conditions, comorbidities, cardiac surgery, higher Pediatric Risk of Mortality III scores, and longer MV duration.
• Use of high-flow nasal cannula oxygen therapy post-extubation increased from 16.6% to 20.2% between 2017 and 2021.

Conclusions:

• Pediatric intensive care units observed improved extubation failure rates from 2017-2021.
• Concomitant increase in postextubation noninvasive respiratory support use was noted.
• Further research is needed to evaluate the clinical impact of these trends in PICU practice.