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Risk factors and outcomes of postoperative extubation failure in children with fourth ventricular tumors: a case
Wenmin Yang1, Jinda Huang1, Feiyan Chen1
1Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center (Guangzhou Medical University), Guangzhou, Guangdong, 510030, China.
Insights
A weak or absent cough reflex significantly increases extubation failure risk in pediatric patients undergoing fourth ventricular tumor surgery. This failure leads to longer mechanical ventilation and hospital stays.
Area of Science:
- Pediatric Neurosurgery
- Critical Care Medicine
- Respiratory Physiology
Background:
- Microsurgical resection of fourth ventricular tumors is a critical treatment for pediatric patients.
- Postoperative extubation failure (EF) is a significant concern, but risk factors remain poorly understood.
- Identifying predictors of EF is crucial for improving patient outcomes.
Purpose of the Study:
- To identify risk factors for extubation failure in children following fourth ventricular tumor resection.
- To determine the association between extubation failure and clinical outcomes in this population.
Main Methods:
- Retrospective study of 103 children undergoing fourth ventricular tumor surgery with an extubation attempt (January 2020 - December 2023).
- Extubation failure defined as re-intubation within 7 days.
- Multivariate logistic regression and bivariate analyses were used to identify risk factors and clinical outcome associations.
Main Results:
- 9.7% of children experienced extubation failure.
- A weak/absent cough reflex was independently associated with EF (OR 41.25, p<0.001).
- Extubation failure correlated with longer mechanical ventilation, PICU, and hospital stays.
Conclusions:
- A weak or absent cough reflex is a significant predictor of extubation failure in pediatric patients after fourth ventricular tumor surgery.
- Extubation failure is linked to substantially worse clinical outcomes, including prolonged resource utilization.
Background And Objective:
Microsurgical resection of tumor is an important treatment for children with fourth ventricular tumors. There is a lack of data describing risk factors for postoperative extubation failure (EF) in these children. We aimed to identify risk factors for EF in children with fourth ventricular tumors and to determine the association between EF and clinical outcomes.
Methods:
A retrospective study review of children after fourth ventricular tumors surgery who had an extubation attempt between January 2020 to December 2023. Extubation failure was defined as re-intubation within 7 days of extubation. Multivariate logistic regression analysis was performed to explore the risk factors for EF. Bivariate statistical analysis was performed to determine associations between EF and clinical outcomes. Only the first extubation attempt was included in the analysis.
Results:
We included 103 children, of whom 10 (9.7%) experienced EF. In the logistic regression analysis, a weak/absent cough reflex was independently associated with EF (p < 0.001). Compared to those with a fair/ strong cough, patients with a weak/absent cough had a odds ratio (OR) of 41.25 for EF (95% CI,8.01-212.37; p < 0.001).Glasgow Coma Score(GCS), the obvious adhesion between the tumor and the fourth ventricle floor, and pulmonary variables were not associated with EF. Children who failed extubation had longer durations of mechanical ventilation [13 days (IQR 6.8-22.8) vs. 1 days (IQR 0.5-3), p < 0.001]; longer PICU lengths of stay [16.5 days (IQR 9.4-27.5) vs. 2 days (IQR1.5-4.3), p < 0.001] and longer hospital lengths of stay [27 days (IQR 21-31.8) vs. 20 days (IQR16-29), p = 0.05] than successfully extubated children.
Conclusions:
Children with weak/absent cough reflex after surgery are at increased risk for extubation failure. Extubation failure is associated with significant adverse outcomes in our setting.
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