CHEST
Volume 119, Issue 3, March 2001, Pages 897-900
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Clinical Investigations in Critical Care
Extubation Failure in a Large Pediatric ICU Population

https://doi.org/10.1378/chest.119.3.897Get rights and content

Objective:

To review a large population of childrenreceiving mechanical ventilation to establish a baseline rate of extubation success and failure and to identify those characteristicsthat place a patient at greater risk of failing plannedextubation.

Design:

Retrospective chart review.

Settings:

University-affiliated children's hospital with a20-bed pediatric ICU.

Patients:

All 632 patientsreceiving mechanical ventilation during the 2-year period from July 1,1996, to June 30, 1998.

Method:

Patients receivingmechanical ventilation were identified via a computerized database. Charts were reviewed of all patients who were reintubated with in72 h of extubation.

Measurements and results

There were 548 planned extubation events, of which 521 were successful. Twenty-seven patients failed planned extubation at least once; only thefirst attempt at extubation was included in the analysis. The failurerate of planned extubations was 4.9%. Including only patients who hadreceived mechanical ventilation for > 24 h before extubation, thefailure rate was 6.0%. For patients intubated > 48 h, the failurerate was 7.9%. The patients who failed extubation were found to besignificantly younger and to have received mechanical ventilationlonger than those who succeeded, in both the analysis of all patientsreceiving mechanical ventilation and the subgroup of those receivingmechanical ventilation > 24 h. When only patients who had receivedmechanical ventilation for > 48 h were analyzed, the difference inage was no longer significant, but the duration of ventilation beforeextubation was still significantly longer for those who failed.

Conclusion:

We determined the overall failure rate of planned extubations in a large population of pediatric patients to be4.9%. Those patients who were younger and had received mechanicalventilation longer were more at risk for extubationfailure.

Section snippets

Materials and Methods

This retrospective chart review was approved by the HumanSubject Protection Committee. A database listing all patients requiringmechanical ventilation in the pediatric ICU (PICU) at the University of California, Los Angeles between July 1, 1996, and June 30, 1998, wascross-referenced with a list of all dates of intubations performed. Charts were reviewed of all patients requiring reintubation with in72 h of having been extubated.

Forty-one percent of the patient population at the University of

Results

There were 632 patients requiring mechanical ventilation duringthe period under review. Of these, 70 died with out ever having beenextubated, leaving 562 patients. Fourteen patients were unintentionallyextubated, leaving 548 patients in the study. Only the first attempt atextubation was included in the analysis. The mean age of the group(± SD) was 52.4 ± 61.4 months, with a median of 22.6 months. Meannumber of ventilator days before extubation was 6.5 ± 17.1 days, with a median of 2 days.

Of the

Discussion

Many factors influence a patient's ability to tolerateextubation. The ability to maintain adequate gas exchange is affectedby central inspiratory drive, respiratory muscle strength, and theworkload placed on the muscles of respiration.91718 Thepositive and negative predictive values of physicians' clinicaljudgment alone in predicting extubation outcome in adult patients wasfound to be 50% and 67%, respectively.19 The predictiveaccuracy of direct measurements of pulmonary function have

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