Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes.
OBJECTIVE
To determine a contemporary failed extubation rate, risk factors, and consequences of extubation failure in pediatric intensive care units (PICUs). Three hypotheses were investigated: a) Extubation failure is in part disease specific; b) preexisting respiratory conditions predispose to extubation failure; and c) admission acuity scoring does not affect extubation failure.


METHODS
Twelve-month prospective, observational, clinical study.


METHODS
Sixteen diverse PICUs in the United States.


METHODS
Patients were 2,794 patients from the newborn period to 18 yrs of age experiencing a planned extubation trial.


METHODS
None.


RESULTS
A descriptive statistical analysis was performed, and outcome differences of the failed extubation population were determined. The extubation failure rate was 6.2% (174 of 2,794; 95% confidence interval, 5.3-7.1). Patient features associated with extubation failure (p <.05) included age < or =24 months; dysgenetic condition; syndromic condition; chronic respiratory disorder; chronic neurologic condition; medical or surgical airway condition; chronic noninvasive positive pressure ventilation; the need to replace the endotracheal tube on admission to the PICU; and the use of racemic epinephrine, steroids, helium-oxygen therapy (heliox), or noninvasive positive pressure ventilation within 24 hrs of extubation. Patients failing extubation had longer pre-extubation intubation time (failed, 148.7 hrs, SD +/- 207.8 vs. success, 107.9 hrs, SD +/- 171.3; p <.001), longer PICU length of stay (17.5 days, SD +/- 15.6 vs. 7.6 days, SD +/- 11.1; p <.001), and a higher mortality rate than patients not failing extubation (4.0% vs. 0.8%; p <.001). Failure was found to be in part disease specific, and preexisting respiratory conditions were found to predispose to failure whereas admission acuity did not.


CONCLUSIONS
A variety of patient features are associated with an increase in extubation failure rate, and serious outcome consequences characterize the extubation failure population in PICUs.
Kurachek
Stephen C
SC
University of Minnesota Department of Pediatrics and Childrens Hospitals and Clinics, Minneapolis, USA.
Newth
Christopher J
CJ
Quasney
Michael W
MW
Rice
Tom
T
Sachdeva
Ramesh C
RC
Patel
Neal R
NR
Takano
Jeanne
J
Easterling
Larry
L
Scanlon
Matthew
M
Musa
Ndidiamaka
N
Brilli
Richard J
RJ
Wells
Dan
D
Park
Gary S
GS
Penfil
Scott
S
Bysani
Kris G
KG
Nares
Michael A
MA
Lowrie
Lia
L
Billow
Michael
M
Chiochetti
Emilie
E
Lindgren
Bruce
B
Scanlon
Mathew
M
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D017211:Treatment Failure