Risk factors for extubation failure in mechanically ventilated pediatric patients

Objective: To describe the incidence of extubation failure and its associated risk factors among mechanically ventilated children. Method: Prospective cohort study. Children who were mechanically ventilated for longer than 12 hrs were followed up to 48 hrs after extubation. Cases of upper airway obstruction, accidental extubation, tracheostomy, or death before extubation were excluded. Extubation failure was defined as reintubation within 48 hrs after extubation. Student's t-test, Mann-Whitney, and chi-squared tests, odds ratio with 95% confidence interval, and multivariate analysis were used for data analysis. Results: Extubation failure rate was 10.5% (13 of 124 patients). Variables associated with extubation failure were age between 1 and 3 mos (odds ratio [OR] = 5.68; 95% confidence interval [CI] = 1.58–20.42), mechanical ventilation >15 days (OR = 6.36; 95% CI = 1.32–30.61), mean oxygenation index (OI) >5 (OR = 4.08; 95% CI = 1.25–13.30), mean airway pressure 24 hrs before extubation lower than 5 cm H2O (OR = 6.03; 95% CI = 1.48–24.60), continuous positive airway pressure (CPAP) (OR = 4.71; 95% CI = 1.34–16.58), dopamine and dobutamine use (OR = 3.71; 95% CI = 1.08–12.78), intravenous sedation >10 days (OR = 6.60; 95% CI = 1.62–26.90), tachypnea and subcostal retractions (relative risk [RR] = 3.68; 95% CI = 1.14–11.93), and inspired fraction of oxygen (Fio2)>0.4 after extubation (RR = 3.63; 95% CI = 1.21–10.88). After multiple logistic regression analysis, age between 1 and 3 mos, mean OI >5, CPAP and mechanical ventilation >15 days remained associated with extubation failure. Conclusion: Extubation failure was more frequent among young infants who received prolonged ventilatory support and intravenous sedation, used CPAP, had impaired lung oxygenation, and required inotropic therapy.