Risk factors for extubation failure in mechanically ventilated pediatric patients.
OBJECTIVE
To describe the incidence of extubation failure and its associated risk factors among mechanically ventilated children.


METHODS
Prospective cohort study. Children who were mechanically ventilated for longer than 12 hrs were followed up to 48 hrs after extubation. Cases of upper airway obstruction, accidental extubation, tracheostomy, or death before extubation were excluded. Extubation failure was defined as reintubation within 48 hrs after extubation. Student's t -test, Mann-Whitney, and chi-squared tests, odds ratio with 95% confidence interval, and multivariate analysis were used for data analysis.


RESULTS
Extubation failure rate was 10.5% (13 of 124 patients). Variables associated with extubation failure were age between 1 and 3 mos (odds ratio [OR] = 5.68; 95% confidence interval [CI] = 1.58-20.42), mechanical ventilation >15 days (OR = 6.36; 95% CI = 1.32-30.61), mean oxygenation index (OI) >5 (OR = 4.08; 95% CI = 1.25-13.30), mean airway pressure 24 hrs before extubation lower than 5 cm H(2)O (OR = 6.03; 95% CI = 1.48-24.60), continuous positive airway pressure (CPAP) (OR = 4.71; 95% CI = 1.34-16.58), dopamine and dobutamine use (OR = 3.71; 95% CI = 1.08-12.78), intravenous sedation >10 days (OR = 6.60; 95% CI = 1.62-26.90), tachypnea and subcostal retractions (relative risk [RR] = 3.68; 95% CI = 1.14-11.93), and inspired fraction of oxygen (Fio(2)) > 0.4 after extubation (RR = 3.63; 95% CI = 1.21-10.88). After multiple logistic regression analysis, age between 1 and 3 mos, mean OI > 5, CPAP and mechanical ventilation >15 days remained associated with extubation failure.


CONCLUSIONS
Extubation failure was more frequent among young infants who received prolonged ventilatory support and intravenous sedation, used CPAP, had impaired lung oxygenation, and required inotropic therapy.
Fontela
Patrícia S
PS
Hospital da Criança Santo Antônio da Irmandade Santa Casa de Misericórdia de Porto Alegre, Brazil.
Piva
Jefferson P
JP
Garcia
Pedro Celiny
PC
Bered
Patrícia L
PL
Zilles
Kátia
K
D001049:Apnea / Q000209:etiology*; D001938:Brazil; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000209:etiology*; D012307:Risk Factors; D017211:Treatment Failure; D015300:Ventilator Weaning / Q000009:adverse effects*
D010100:Oxygen