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Extubation Failure in a Large Pediatric ICU Population^*

^* From the Division of Pediatric Critical Care, Mattel Children’s Hospital, UCLA Medical Center, Los Angeles, CA.

Correspondence to: Rick Harrison, MD, Pediatric Critical Care, Mattel Children’s Hospital, UCLA Medical Center, 10833 LeConte Ave, Los Angeles, CA 90024-1783

Objective: To review a large population of children receiving mechanical ventilation to establish a baseline rate of extubation success and failure and to identify those characteristics that place a patient at greater risk of failing planned extubation.

Design: Retrospective chart review.

Setting: University-affiliated children’s hospital with a 20-bed pediatric ICU.

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

Method: Patients receiving mechanical ventilation were identified via a computerized database. Charts were reviewed of all patients who were reintubated within 72 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 the first attempt at extubation was included in the analysis. The failure rate of planned extubations was 4.9%. Including only patients who had received mechanical ventilation for > 24 h before extubation, the failure rate was 6.0%. For patients intubated > 48 h, the failure rate was 7.9%. The patients who failed extubation were found to be significantly younger and to have received mechanical ventilation longer than those who succeeded, in both the analysis of all patients receiving mechanical ventilation and the subgroup of those receiving mechanical ventilation > 24 h. When only patients who had received mechanical ventilation for > 48 h were analyzed, the difference in age was no longer significant, but the duration of ventilation before extubation 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 be 4.9%. Those patients who were younger and had received mechanical ventilation longer were more at risk for extubation failure.

Key Words: artificial respiration • child • infant • respiratory failure

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