title: Do in-hours or off-hours matter for extubating children in the pediatric intensive care unit?
abstract: Several studies have suggested worse outcomes for patients requiring medical care at night or on weekends. However, whether or not children should be extubated only during in-hours has not been studied yet. We sought to compare outcomes and complications of in-hours versus off-hours extubated patients.
  
  
  
  We prospectively included all children receiving invasive mechanical ventilation (MV) in a pediatric intensive care unit. Off-hours extubations included patients who were extubated at nighttime (8:00 pm-7:59 am) plus weekends/holidays whereas the in-hours extubations included regular daytime weekdays (Monday to Friday: 8:00 am-7:59 pm).
  
  
  
  Of the 480 patients, 346 (72%) were extubated during in-hours period and 134 (28%) were extubated during off-hours. In-hours patients spent a longer time to have planned extubation and had a longer MV duration and pediatric intensive care unit stay compared to those extubated at off-hours. Kaplan-Meier curve showed that in-hours patients were more likely to have a longer time until the first extubation (log-rank test: P=.006, HR: 5.05).
  
  
  
  Patients extubated at off-hours had more favorable outcomes with similar complications rate compared with those extubated at in-hours. These results provide no support for delaying extubations until in-hours period. Further studies are required to confirm these findings.
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil. Electronic address: psls.nat@terra.com.br.
authors.forename: Paulo Sérgio Lucas
authors.initials: PS
authors.lastname: da Silva
authors.affiliation: Hospital e Maternidade Santa Joana, São Paulo, Brazil. Electronic address: eunice.resi@terra.com.br.
authors.forename: Maria Eunice
authors.initials: ME
authors.lastname: Reis
authors.affiliation: Faculdade de Medicina do ABC, Santo André, Sào Paulo, Brazil. Electronic address: thais.smfonseca@gmail.com.
authors.forename: Thais Suelotto Machado
authors.initials: TS
authors.lastname: Fonseca
authors.affiliation: Health Technologies Assessment Center - Federal University of São Paulo, São Paulo, Brazil. Electronic address: marcelo.fonseca@axia.bio.br.
authors.forename: Marcelo Cunio Machado
authors.initials: MC
authors.lastname: Fonseca
mesh_terms: D039602:After-Hours Care; D060666:Airway Extubation / Q000379:methods*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D013997:Time Factors; D015300:Ventilator Weaning
keywords: Children; Extubation; Mechanical ventilation; Outcomes; Pediatric intensive care