Document Detail


Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes.
MedLine Citation:
PMID:  14605539     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine a contemporary failed extubation rate, risk factors, and consequences of extubation failure in pediatric intensive care units (PICUs). Three hypotheses were investigated: a) Extubation failure is in part disease specific; b) preexisting respiratory conditions predispose to extubation failure; and c) admission acuity scoring does not affect extubation failure. DESIGN: Twelve-month prospective, observational, clinical study. SETTING: Sixteen diverse PICUs in the United States. PATIENTS: Patients were 2,794 patients from the newborn period to 18 yrs of age experiencing a planned extubation trial. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A descriptive statistical analysis was performed, and outcome differences of the failed extubation population were determined. The extubation failure rate was 6.2% (174 of 2,794; 95% confidence interval, 5.3-7.1). Patient features associated with extubation failure (p <.05) included age < or =24 months; dysgenetic condition; syndromic condition; chronic respiratory disorder; chronic neurologic condition; medical or surgical airway condition; chronic noninvasive positive pressure ventilation; the need to replace the endotracheal tube on admission to the PICU; and the use of racemic epinephrine, steroids, helium-oxygen therapy (heliox), or noninvasive positive pressure ventilation within 24 hrs of extubation. Patients failing extubation had longer pre-extubation intubation time (failed, 148.7 hrs, SD +/- 207.8 vs. success, 107.9 hrs, SD +/- 171.3; p <.001), longer PICU length of stay (17.5 days, SD +/- 15.6 vs. 7.6 days, SD +/- 11.1; p <.001), and a higher mortality rate than patients not failing extubation (4.0% vs. 0.8%; p <.001). Failure was found to be in part disease specific, and preexisting respiratory conditions were found to predispose to failure whereas admission acuity did not. CONCLUSION: A variety of patient features are associated with an increase in extubation failure rate, and serious outcome consequences characterize the extubation failure population in PICUs.
Authors:
Stephen C Kurachek; Christopher J Newth; Michael W Quasney; Tom Rice; Ramesh C Sachdeva; Neal R Patel; Jeanne Takano; Larry Easterling; Matthew Scanlon; Ndidiamaka Musa; Richard J Brilli; Dan Wells; Gary S Park; Scott Penfil; Kris G Bysani; Michael A Nares; Lia Lowrie; Michael Billow; Emilie Chiochetti; Bruce Lindgren; Mathew Scanlon
Related Documents :
11397019 - A model for national outcome audit in vascular surgery.
12808539 - Locked-in syndrome: improvement in the prognosis after an early intensive multidiscipli...
24857639 - Diagnostic accuracy of central venous saturation in estimating mixed venous saturation ...
19583609 - Quality improvement program increases early tracheal extubation rate and decreases pulm...
3462549 - An orthopaedic geriatric rehabilitation unit: the first two years experience.
18511439 - Influence of systolic-pressure-variation-guided intraoperative fluid management on orga...
23972739 - Arterial hyperoxia during cardiopulmonary bypass and postoperative cognitive dysfunction.
15534729 - Ten years experience of thoracic and thoracoabdominal aortic aneurysm surgical repair: ...
21822919 - Results of the total evolutive shoulder system (tess(®)): a single-centre study of 56 ...
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  31     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-11-07     Completed Date:  2003-12-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2657-64     Citation Subset:  AIM; IM    
Affiliation:
University of Minnesota Department of Pediatrics and Childrens Hospitals and Clinics, Minneapolis, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Child
Child, Preschool
Data Collection
Female
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric / statistics & numerical data*
Intubation, Intratracheal*
Logistic Models
Male
Risk Factors
Treatment Failure*
Comments/Corrections
Erratum In:
Crit Care Med. Jul;32(7):1632-3
Note: Scanlon Mathew [corrected to Scanlon Matthew]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Long-term outcome in intensive care unit survivors after mechanical ventilation for intracerebral he...
Next Document:  Clinical practice guidelines for the maintenance of patient physical safety in the intensive care un...