Pediatric Cardiac Intensivist CIncinnati Children's Hospital Medical Center Cincinnati, OH, Ohio, United States
Abstract:
Objective: To describe the clinical epidemiology of unplanned extubations (UE), including adverse outcomes, in a multicenter cohort of patients in pediatric cardiac ICUs (CICU).
Design: Retrospective cohort study of clinical registry data. Setting: 45 Pediatric Cardiac Critical Care Consortium hospitals. Patients: All patients receiving mechanical ventilation (MV) via an endotracheal tube in a CICU from August 2014 to October 2020. Interventions: None. Measurements and Main
Results: The incidence and outcome of UE was evaluated in medical and surgical patient cohorts. The overall UE rate was 2.8%. In the cardiac surgical group, those with UE had a longer duration of MV, while UE did not impact duration of MV in medical patients. In both cohorts, those with UE were younger, more likely underweight, and more likely to have an airway anomaly. In multivariable logistic regression, airway anomaly was associated with UE in all patients. Younger age, higher STAT category, longer duration of MV, and initial oral rather than nasal airway were associated with UE in the surgical group but not the medical group. UE was associated with a higher reintubation rate compared to elective extubation (26.8 versus 4.8%, p< 0.001) within one day of event. Patients with UE had a higher incidence of ventilator associated pneumonia (VAP) (0.5 versus 0.1%, p=0.005), cardiac arrest (3.1 versus 0.5%, p< 0.001) and use of mechanical circulatory support (MCS) (0.4% versus 0.1%, p=0.012). There was no difference in mortality.
Conclusions: There is an increased incidence of cardiac arrest, VAP, and MCS in pediatric cardiac patients who undergo UE compared to those with planned extubation. Cardiac medical and surgical patients have varying risk factors for UE in the CICU, and there are specific modifiable risk factors for UE. Knowledge of these factors can help guide further collaboration and interventions to improve outcomes in this population.
