Pediatrics ·
Extubation Failure Occurred After 6.7% of Planned Extubations in UK PICUs
A post hoc secondary analysis of the 2018–2019 SandWiCh trial dataset included 9,215 children with a planned extubation across 18 UK PICUs. Emergency reintubation within 48 hours followed 6.7% of first planned extubations; higher PIM-3 scores and longer ventilation before extubation were associated with greater odds of failure.
- Extubation failure followed 6.7% of first planned attempts.
- Analysis included 9,215 children across 18 UK PICUs.
- Higher PIM-3 and longer ventilation were associated with failure.
- Stridor occurred in 28% of children with failure.
Researchers conducted a post hoc, non-prespecified secondary analysis of the SandWiCh trial dataset, covering children admitted to 18 UK pediatric intensive care units in 2018–2019. The analysis included 9,215 children with at least one planned extubation attempt. The primary outcome was extubation failure, defined as emergency reintubation within 48 hours. Children with unplanned extubations or certain other exclusions were not included in the patient-level analysis.
Failure followed the first planned extubation in 618 children (6.7%). In multivariable analysis, higher Pediatric Index of Mortality 3 scores and longer duration of mechanical ventilation before extubation were associated with greater odds of failure. Postextubation stridor occurred in 874 children (9.4%) overall and in 173 of the 618 children with extubation failure (28%).
The findings provide a UK multicentre estimate that the authors describe as comparable with published cohorts, and identify factors associated with failure in this population. Because this was a secondary, non-prespecified analysis, the associations do not establish causation or determine an individual child’s risk. The reported findings do not test an intervention to prevent extubation failure.
In practice
Among children in this UK PICU dataset who underwent planned extubation, 6.7% required emergency reintubation within 48 hours. Higher PIM-3 scores and longer pre-extubation ventilation were associated with greater odds of failure, while stridor was reported in 28% of children with failure. These findings may inform understanding of risk in similar populations, but they come from a post hoc, non-prespecified analysis and do not establish causality or support a specific change in extubation management.
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Pediatric Critical Care Medicine: Extubation Failure in Pediatric Critical Care: A Secondary Analysis of the 2018–2019 Sedation and Weaning in Children (SandWiCh) Trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.