Table1_Predictive factors of extubation failure in pediatric cardiac intensive care unit: A single-center retrospective study from Thailand.docx

Introduction/objectiveExtubation failure increases morbidity and mortality in pediatric cardiac patients, a unique population including those with congenital heart disease or acquired heart disease. This study aimed to evaluate the predictive factors of extubation failure in pediatric cardiac patients and to determine the association between extubation failure and clinical outcomes.
MethodsWe conducted a retrospective study in the pediatric cardiac intensive care unit (PCICU) of the Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, from July 2016 to June 2021. Extubation failure was defined as the re-insertion of the endotracheal tube within 48 hours after extubation. Multivariable log-binomial regression with generalized estimating equations (GEE) was performed to explore the predictive factors associated with extubation failure.
ResultsWe collected 318 extubation events from 246 patients. Of these, 35 (11%) events were extubation failures. In physiologic cyanosis, the extubation failure group had significantly higher SpO2 than the extubation success group (P < 0.001). The predictive factors associated with extubation failure included a history of pneumonia before extubation (RR 3.09, 95% CI 1.54–6.23, P = 0.002), stridor after extubation (RR 2.57, 95% CI 1.44–4.56, P = 0.001), history of re-intubation (RR 2.24, 95% CI 1.21–4.12, P = 0.009), and palliative surgery (RR 1.87, 95% CI 1.02–3.43, P = 0.043).
ConclusionExtubation failure was identified in 11% of extubation attempts in pediatric cardiac patients. The extubation failure was associated with a longer duration of PCICU stay but not with mortality. Patients with a history of pneumonia before extubation, history of re-intubation, post-operative palliative surgery, and post-extubation stridor should receive careful consideration before extubation and close monitoring afterward. Additionally, patients with physiologic cyanosis may require balanced circulation via regulated SpO2.

拔管失败会增加儿科心脏患者的发病率与死亡率，该特殊人群涵盖先天性心脏病及获得性心脏病患者。本研究旨在评估儿科心脏患者拔管失败的预测因素，并明确拔管失败与临床结局之间的关联。
研究方法：本研究于2016年7月至2021年6月期间，在泰国清迈清迈大学医学院小儿心脏重症监护病房（PCICU）开展回顾性研究。本研究将拔管失败定义为拔管后48小时内重新置入气管导管。本研究采用结合广义估计方程（GEE）的多变量对数二项回归分析，探究与拔管失败相关的预测因素。
研究结果：本研究共收集246例患者的318次拔管操作数据，其中35次（11%）为拔管失败事件。在合并生理性发绀的患者中，拔管失败组的脉搏血氧饱和度（SpO2）显著高于拔管成功组（P<0.001）。与拔管失败相关的预测因素包括：拔管前肺炎病史（相对危险度RR=3.09，95%置信区间CI=1.54~6.23，P=0.002）、拔管后喘鸣（RR=2.57，95%CI=1.44~4.56，P=0.001）、再次气管插管病史（RR=2.24，95%CI=1.21~4.12，P=0.009）以及姑息手术史（RR=1.87，95%CI=1.02~3.43，P=0.043）。
研究结论：儿科心脏患者的拔管失败率为11%。拔管失败与小儿心脏重症监护病房（PCICU）住院时长延长相关，但与患者死亡率无显著关联。对于存在拔管前肺炎病史、再次气管插管病史、术后姑息手术史以及拔管后喘鸣的患者，临床医师应在拔管前进行充分评估，并在拔管后给予密切监测。此外，合并生理性发绀的患者可能需要通过调控SpO2以维持循环稳态。