Abstract
BACKGROUND: Pediatric extubation failure is associated with morbidity and mortality. The most common cause is upper-airway obstruction. Subglottic edema is common, but upper-airway obstruction can occur from the oral cavity to the trachea. Dichotomous categorization of extuba-tion failure as airway versus non-airway may help identify risk factors as well as strategies that translate to lower extubation failure rates. METHODS: This was as single-center, retrospective cohort study of invasive mechanical ventilation encounters within a quality improvement database between October 1, 2017–November 30, 2020. Utilizing a 3-physician adjudication process, all extubation failures were categorized as airway versus non-airway. Primary outcome was failure subtype prevalence. Secondary outcome was failure subtype risk factors. Clinical outcomes were explored. RESULTS: The all-cause extubation failure rate was 10% in a cohort of 844 encounters. Airway and non-airway extubation failure represented 60.7% and 39.3%, respectively. Most airway failures were due to upper-airway obstruction (84.3%)—35.3% were supraglottic, 25.5% subglottic, and 23.5% mixed. Other causes of airway failure were airway patency/secretions (11.8%) and aspi-ration (3.9%). Non-airway failures were attributed to respiratory failure (75.8%), encephalopathy (15.2%), and other (9%). All-cause extubation failure was associated with dysgenetic/syndromic comorbidity (P 5.005), 6 3 concurrent comorbid conditions (P 5.007), indication for invasive ventilation (P <.001), and longer invasive mechanical ventilation duration (P <.001). Airway extubation failure was significantly associated with the presence of a respiratory comorbidity (P 5.01) and Glasgow coma scale < 10 (P 5.02). No significant non-airway failure risk factors were identified. Longer pediatric ICU (PICU) stay (P <.001) and PICU mortality (P <.001) were associated with all-cause extubation failure. No significant outcome associations with extubation failure subtype were identified. CONCLUSIONS: Airway extubation failure prevalence was 1.5 times higher than non-airway failure. Potential risk factors for airway failure were identified. These findings are hypothesis generating for future study focused on key evidence gaps and pragmatic bedside application.
Original language | English (US) |
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Pages (from-to) | 374-383 |
Number of pages | 10 |
Journal | Respiratory care |
Volume | 68 |
Issue number | 3 |
DOIs | |
State | Published - Mar 1 2023 |
Externally published | Yes |
Keywords
- airway obstruction
- extubation
- laryngeal edema
- mechanical ventilation
- pediatrics
- stridor
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine