Extubation failure in pediatric intensive care unit: a retrospective cohort study

ABSTRACT In the pediatric intensive care unit (ICU), extubation failure may increase mortality risk. This study aimed: (1) to verify the rate of extubation failure in the pediatric ICU of a public hospital located in the city of Bauru (São Paulo, Brazil); (2) to identify the main cause attributed to extubation failure; (3) to evaluate whether age and time of invasive mechanical ventilation (IMV) are characteristics associated to extubation failure; (4) to evaluate whether the length of stay in the ICU/hospital is longer among patients who presented extubation failure. A retrospective study was performed with 89 hospitalized patients from May 2017 to July 2018. Results showed an extubation failure rate corresponding to 16%. The main cause attributed to extubation failure was laryngeal stridor, totaling 57% of the cases. Intergroup comparison (success vs. failure of extubation) showed no differences in relation to age (p=0.294) and IMV time (p=0.228). However, we observed that the extubation failure group had longer ICU (p=0.000) and hospital time (p=0.010). In this way, we conclude that the rate of extubation failure is in agreement with other studies. Laryngeal stridor was responsible for more than half of cases of extubation failure. Although IMV time and age were not associated with the extubation failure, they contributed to a longer stay in the ICU and in the hospital.

摘要 在儿科重症监护病房（ICU）中，拔管失败会升高患者的死亡风险。本研究旨在达成四项目标：（1）验证巴西圣保罗州包鲁市某公立医院儿科ICU的拔管失败率；（2）明确拔管失败的主要归因病因；（3）评估年龄与有创机械通气（Invasive Mechanical Ventilation, IMV）时长是否为与拔管失败相关的临床特征；（4）对比拔管失败患者与成功患者的ICU及住院总停留时长是否存在差异。本研究为回顾性研究，纳入2017年5月至2018年7月间的89名住院患者。研究结果显示，本次研究的拔管失败率为16%。拔管失败的主要病因是喉喘鸣，占所有失败病例的57%。组间对比（拔管成功组与失败组）显示，两组在年龄（p=0.294）与有创机械通气时长（p=0.228）上均无统计学差异。但拔管失败组的ICU停留时长（p=0.000）与住院总时长（p=0.010）均显著长于成功组。综上，本研究的拔管失败率与既往同类研究结果一致，喉喘鸣是超过半数拔管失败病例的致病原因。尽管有创机械通气时长与年龄与拔管失败无显著关联，但二者与更长的ICU及住院停留时长相关。