title: Incidence and Risk Factors for Cardiovascular Collapse After Unplanned Extubations in the Pediatric ICU.
abstract: BACKGROUND
  Cardiovascular collapse is a life-threatening event after unplanned extubations (UEs) in the pediatric ICU (PICU). However, there is a paucity of pediatric studies assessing this complication. We sought to assess the incidence, risk factors, and outcome of cardiovascular collapse after UEs in PICU patients.
  
  
  METHODS
  All children who had been mechanically ventilated for ≥12 h were prospectively tracked for UEs over an 8-y period. Subjects were included in the study if they were between ages 1 month and 16 y and had experienced UE. They were analyzed in 2 groups: those with cardiovascular collapse (defined as the need for cardiopulmonary resuscitation or circulatory dysfunction immediately after UE) and those with no cardiovascular collapse.
  
  
  RESULTS
  Of the 847 subjects, 109 UEs occurred in 14,293 intubation days (0.76 UEs/100 intubation days), with 21 subjects (19.2%) experiencing cardiovascular collapse, of which 10 required cardiopulmonary resuscitation. Compared with subjects without cardiovascular collapse after UE, children with cardiovascular collapse were younger (<6 months old), with respiratory failure from lower respiratory tract diseases, lower PaO2/FIO2(218 vs 282 mm Hg), and higher oxygenation indices (5.5 vs 3.5) before UE events. Logistic regression revealed that only an age ≤6 months old was strongly associated with cardiovascular collapse (odds ratio 3.4,P= .03). There were no differences between cardiovascular collapse and non-cardiovascular collapse subjects regarding the length of hospital stay, ventilator-associated pneumonia rate, and mortality.
  
  
  CONCLUSIONS
  Cardiovascular collapse is a frequent complication of UEs, particularly in the youngest children. Specific bundles to prevent UEs may reduce morbidity related to these events.
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil. psls.nat@terra.com.br.
authors.forename: Paulo Sérgio
authors.initials: PS
authors.lastname: Lucas da Silva
authors.affiliation: Health Technology Assessment Unit, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Marcelo Cunio Machado
authors.initials: MCM
authors.lastname: Fonseca
mesh_terms: D000293:Adolescent; D000367:Age Factors; D060666:Airway Extubation / Q000009:adverse effects*; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D012769:Shock / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy
keywords: complications; endotracheal extubation; outcomes; pediatric intensive care unit; unplanned extubation