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Updated: May 26, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Early extubations in children intubated prior to arrival in Paediatric Burn ICU: A single center retrospective study
Sébastien Lebrun1, Nicolas Louvet1, Nada Sabourdin2
1Sorbonne Université, GRC 29, Groupe de Recherche Clinique en Anesthésie Réanimation médecine Périopératoire, ARPE, F-75013 Paris, France; Département d'Anesthésie-Réanimation, AP-HP, Hôpital Trousseau, F-75012 Paris, France.
Insights
In pediatric burn intensive care units, 36% of intubated children experienced potentially unnecessary intubation (PUNI), similar to adult rates. This study identified factors predicting potentially necessary intubation (PNI) in pediatric burn patients.
Area of Science:
- Pediatric critical care medicine
- Burn intensive care
- Intubation and mechanical ventilation
Background:
- Potentially unnecessary intubation (PUNI) is common in adult burn intensive care units (ICUs), affecting over 30% of intubated patients.
- Data on PUNI rates in pediatric populations are scarce, necessitating further investigation.
- Understanding PUNI in children is crucial for optimizing respiratory support and resource allocation in pediatric burn care.
Purpose of the Study:
- To determine the rate of potentially unnecessary intubation (PUNI) in pediatric burn patients admitted to the ICU.
- To identify factors associated with potentially necessary intubation (PNI) in this cohort.
- To develop a predictive score for PNI in pediatric burn patients.
Main Methods:
- Retrospective analysis of 1520 pediatric burn intensive care unit admissions over 8 years.
- Primary outcome: assessment of PUNI rate (extubation within 2 days of arrival).
- Logistic regression models used to identify factors associated with PNI and develop a predictive score.
Main Results:
- Of 56 children admitted intubated, 20 (36%) were classified as PUNI.
- Children with PUNI had significantly smaller total body surface area (%TBSA) burns compared to those with PNI (24% vs. 48%, p=0.002).
- A predictive score for PNI was developed, incorporating %TBSA burned, flame burns, and facial burns.
Conclusions:
- Potentially unnecessary intubation (PUNI) in pediatric burn patients admitted to the ICU occurs at a rate comparable to adults.
- Factors such as %TBSA burned, flame burns, and facial burns are independently associated with potentially necessary intubation (PNI).
- The developed predictive score can aid in identifying pediatric burn patients likely to require prolonged intubation.
Background:
In adult burns intensive care units, more than 30% of patients arriving intubated, are extubated within 2 days (potentially unnecessary intubation, PUNI). Such data are lacking in paediatric populations. Exploring this paediatric PUNI rate was the primary aim of the study.
Methods:
Data from all the admissions to our paediatric burn intensive care unit were retrospectively analyzed over an 8-years period. Extubations within the first two days among patients arriving intubated were assessed as the primary outcome (PUNI rate). Using a univariate logistic regression and a multivariate model, we analyzed factors associated with intubation lasting more than 2 days (potentially necessary intubation, PNI). Finally, we developed a score to predict the probability of PNI.
Results:
Among the 1520 admitted children (age: 0-17; Percentage of Total Body Surface Area (%TBSA): 1%-97%), 56 (4%) arrived intubated, 20 (36%) of whom were considered PUNI. These patients had smaller %TBSA burned compared to those having PNI (24% ± 17% vs. 48% ± 24%, p = 0.002). We developed a score based on factors independently associated with PNI: %TBSA burned (OR = 1.12 [1.09-1.15] for each additional per cent), flame burns (OR = 4.43 [1.64-11.6]) and facial burns (OR = 12.28 [3.41-67.4]). Seven children (<0.5%) were intubated after admission.
Conclusion:
Intubation before admission to a burn intensive care unit was less frequent in children. The paediatric rate of PUNI, however, was close to findings reported in adults: approximately one-third of intubated children were extubated within 2 days.
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