Risk factors for extubation failure in the intensive care unit

The present case-control study was conducted in an intensive care unit. Failed extubations were used as cases, while successful extubations were used as controls. Extubation failure was defined as reintubation being required within the first 48 hours of extubation.

Results:

Out of a total of 956 patients who were admitted to the intensive care unit, 826 were subjected to mechanical ventilation (86%). There were 30 failed extubations and 120 successful extubations. The proportion of failed extubations was 5.32%. The risk factors found for failed extubations were a prolonged length of mechanical ventilation of greater than 7 days (OR = 3.84, 95%CI = 1.01 - 14.56, p = 0.04), time in the intensive care unit (OR = 1.04, 95%CI = 1.00 - 1.09, p = 0.03) and the use of sedatives for longer than 5 days (OR = 4.81, 95%CI = 1.28 - 18.02; p = 0.02).

Conclusion:

Pediatric patients on mechanical ventilation were at greater risk of failed extubation if they spent more time in the intensive care unit and if they were subjected to prolonged mechanical ventilation (longer than 7 days) or greater amounts of sedative use.

Keywords:
Risk factors; Airway extubation; Respiration, artificial; Intensive care units, pediatric

Variable	Cases (FE) n = 30	Controls (SE) n = 120	p value
Sex^† † chi-squared test.
Male	18 (60.00)	76 (63.33)	0.73
Age (years)^‡ ‡ Mann-Whitney U test.	1 (0.3 - 4)	2 (0.2 - 9)	0.29
Weight (kg)	7.15 (4.38 - 15.5)	12 (4.97 - 27.75)	0.09
MV days > 7 days^† † chi-squared test.	24 (80.00)	28 (23.33)	<0.001^* * p < 0.05.
Days in ICU^‡ ‡ Mann-Whitney U test.	30.5 (13 - 68)	4 (1 - 9.5)	<0.001^* * p < 0.05.
Reason for admission^† † chi-squared test.			0.001^* * p < 0.05.
Respiratory	17 (56.67)	31 (25.83)
Non-respiratory	13 (43.33)	89 (74.17)
PRISM^‡ ‡ Mann-Whitney U test.	9.5 (5 - 16)	9 (5 - 13)	0.34
Respiratory frequency^‡ ‡ Mann-Whitney U test.	28 (19 - 36)	21 (16 - 30)	0.06
FiO₂^§ § Student’s t-test. Results are expressed as number (%), median (interquartile range) or mean ± standard deviation.	33.43 ± 9.76	32.7 ± 8.01	0.66
Tidal volume (mL/kg)^‡ ‡ Mann-Whitney U test.	15.5 (12 - 85)	34.5 (12-138)	0.48
Volume minute (mL/kg)^‡ ‡ Mann-Whitney U test.	480 (336-1190)	882 (275-2680)	0.35
PaO₂^§ § Student’s t-test. Results are expressed as number (%), median (interquartile range) or mean ± standard deviation.	95.64 ± 43.73	119.99 ± 57.97	0.33
PIP^§ § Student’s t-test. Results are expressed as number (%), median (interquartile range) or mean ± standard deviation.	17.54 ± 4.72	17,30 ± 3,39	0.75
Ventilation mode prior to extubation^† † chi-squared test.			0.03^* * p < 0.05.
Spontaneous	13 (43.33)	29 (24.17)
SIMV	9 (30.00)	52 (43.33)
A/C	7 (23.33)	31 (25.83)
Inotropic use^† † chi-squared test.	12 (40.00)	65 (54.17)	0.16
Use of sedation ev^† † chi-squared test. > 5 days	21 (70.00)	61 (50.83)	0.05
Use of dexamethasone^† † chi-squared test.	25 (83.33)	82 (68.33)	0.10
Use of nebulized adrenaline^† † chi-squared test.	11 (36.67)	79 (65.83)	0.004^* * p < 0.05.

Independent variables	OR raw	Adjusted OR	IC95%
Time in ICU (days)	1.07	1.04	1.00 - 1.09
VM time > 7 days	13,14	3.84	1.01 - 14.56
Use of sedatives > 5 days	2.25	4.81	1.28 - 18.02
Use of inotropes > 10 days	0.56	0.34	0.10 - 1.12
Use of nebulized adrenaline	0.30	0.34	0.11 - 1.04
Use of dexamethasone	2.31	2.01	0.52 - 7.71
Reason for admission to the ICU	3.75	1.40	0.43 - 4.45
Ventilation mode	0.78	0.98	0.69 - 1.38

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E-mail: rbti.artigos@amib.com.br

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[1] Corresponding author: Aracely Lizet Silva-Cruz, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Avda. San Marcos cuadra 2, Chorrillos, Lima, Perú, E-mail: aracely.silva44@gmail.com