Prevalence of extubation and associated risk factors at a tertiary care pediatric intensive care unit

Abstract

Introduction. Extubation failure (EF) is associated with a higher risk for pneumonia, hospital stay, and mortality. Objective.TodeterminetheprevalenceofEFand identifytheassociatedfactorsinourpopulation. Materials and methods. Observational and retrospective design. All patients aged 1 month old to 18 years old who required mechanical ventilationformorethan12hoursandunderwent at least one scheduled extubation during their stay in the 2012-2016 period were included. The aspects related to ventilation and the causes of failure were recorded. Results. Seven hundred and thirty-one patients were extubated and the prevalence of EF was 19.3 %. The causes of failure included upper airway obstruction (51.4 %), muscle fatigue (20.1 %), respiratory center depression (14.6 %), andinabilitytoprotecttheairways(9.7%).Asper themultivariateanalysis,theindependentfactors thataccountedforEFwereneurologicalcomplex chronic condition (odds ratio [OR] = 2.27; 95 % confidence interval [CI] = 1.21-4.26); acute lower respiratory tract infection in a patient with prior sequelae (OR = 1.87, 95 % CI = 1.11-3.15); acute neurological injury (OR = 1.92, 95 % CI=1.03-3.57);unplannedextubation(OR=2.52, 95 % CI = 1.02-6.21), and presence of stridor (OR = 5.84, 95 % CI = 3.66-9.31). Conclusion. The main cause of EF was upper airwayobstruction.Neurologicalsequelae,acute neurological injury, unplanned extubation, and the presence of postextubation stridor were identified as risk factors associated with EF.