title: Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes.
abstract: 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.
authors: University of Minnesota Department of Pediatrics and Childrens Hospitals and Clinics, Minneapolis, USA.
authors: Stephen C
authors: SC
authors: Kurachek
authors: Christopher J
authors: CJ
authors: Newth
authors: Michael W
authors: MW
authors: Quasney
authors: Tom
authors: T
authors: Rice
authors: Ramesh C
authors: RC
authors: Sachdeva
authors: Neal R
authors: NR
authors: Patel
authors: Jeanne
authors: J
authors: Takano
authors: Larry
authors: L
authors: Easterling
authors: Matthew
authors: M
authors: Scanlon
authors: Ndidiamaka
authors: N
authors: Musa
authors: Richard J
authors: RJ
authors: Brilli
authors: Dan
authors: D
authors: Wells
authors: Gary S
authors: GS
authors: Park
authors: Scott
authors: S
authors: Penfil
authors: Kris G
authors: KG
authors: Bysani
authors: Michael A
authors: MA
authors: Nares
authors: Lia
authors: L
authors: Lowrie
authors: Michael
authors: M
authors: Billow
authors: Emilie
authors: E
authors: Chiochetti
authors: Bruce
authors: B
authors: Lindgren
authors: Mathew
authors: M
authors: Scanlon
mesh_terms: 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