Intructor Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Thailand Chiang Mai, MA, Thailand
Abstract: Introduction /
Objective: Extubation failure increases morbidity and mortality in pediatric cardiac patients, a unique population including those with congenital heart disease or acquired heart disease. This study aims to evaluate the prognostic factors of extubation failure in pediatric cardiac patients and to determine the impact of extubation failure on clinical outcomes.
Methods: We 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 reinsertion of endotracheal tube within 48 hours after extubation. The generalized equating estimation (GEE) was performed to explore the prognostic factors that are associated with extubation failure.
Results: We 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 prognostic factors associated with extubation failure included low body mass index (OR = 0.84, 95% CI = 0.71-0.99; p = 0.04), diagnosis of pneumonia (OR = 4.46, 95% CI = 1.90-10.47; p = 0.001), history of re-intubation (OR = 2.79, 95% CI = 1.02-7.61; p = 0.04), post-operative palliative surgery (OR = 2.96, 95% CI = 1.27-6.92; p = 0.01), and post-extubation stridor (OR = 3.76, 95% CI = 1.72-8.24; p = 0.001). Additionally, the patients who failed extubation occupied PCICU longer than those without extubation failure (median (IQR): 26 (14,45) days vs. 7 (4,14) days, p < 0.001).
Conclusion: Extubation failure was identified in 11% of extubation events. Notably, there was a longer PCICU stay in patients with extubation failure than those without. Patients with physiologic cyanosis may require balanced circulation via regulated SpO2. Patients with low body mass index, diagnosis of pneumonia, history of re-intubation, post-operative palliative surgery, and post-extubation stridor should receive careful consideration before extubation and close monitoring afterward.
