| Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes. | |
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MedLine Citation:
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PMID: 14605539 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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 |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Critical care medicine Volume: 31 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-11-07 Completed Date: 2003-12-10 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 2657-64 Citation Subset: AIM; IM |
Affiliation:
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University of Minnesota Department of Pediatrics and Childrens Hospitals and Clinics, Minneapolis, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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
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