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Multicenter Study
. 2023 Jul 1;24(7):551-562.
doi: 10.1097/PCC.0000000000003235. Epub 2023 Apr 17.

Unplanned Extubation During Pediatric Cardiac Intensive Care: U.S. Multicenter Registry Study of Prevalence and Outcomes

Tanya Perry  1 , Darren Klugman  2 , Kurt Schumacher  3 , Mousumi Banerjee  4 , Wenying Zhang  3 , Rebecca Bertrandt  5 , Joshua S Wolovits  6 , Lee D Murphy  7 , Andrew M Misfeldt  1 , Jeffrey Alten  1 , David S Cooper  1
Affiliations
Multicenter Study

Unplanned Extubation During Pediatric Cardiac Intensive Care: U.S. Multicenter Registry Study of Prevalence and Outcomes

Tanya Perry et al. Pediatr Crit Care Med. .

Abstract

Objectives: The epidemiology of unplanned extubations (UEs) and associated adverse outcomes in pediatric cardiac ICUs (CICU).

Design: Registry data (August 2014 to October 2020).

Setting: Forty-five Pediatric Cardiac Critical Care Consortium hospitals.

Patients: Patients receiving mechanical ventilation (MV) via endotracheal tube (ETT).

Interventions: None.

Measurements and main results: Fifty-six thousand five hundred eight MV courses occurred in 36,696 patients, with a crude UE rate of 2.8%. In cardiac surgical patients, UE was associated with longer duration of MV, but we failed to find such association in medical patients. In both cohorts, UE was associated with younger age, being underweight, and airway anomaly. In multivariable logistic regression, airway anomaly was associated with UE in all patients. Younger age, higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score category, longer duration of MV, and initial oral rather than nasal ETT are associated with UE in the surgical group, but we failed to find such associations in the medical group. UE was associated with a higher reintubation rate compared with elective extubation (26.8 vs 4.8%; odds ratio [OR], 7.35; 95% CI, 6.44-8.39; p < 0.0001) within 1 day of event. After excluding patients having redirection of care, UE was associated with at least three-fold greater odds for each of ventilator-associated pneumonia (VAP), cardiac arrest, and use of mechanical circulatory support (MCS). However, we failed to identify an association between UE and greater odds of mortality (1.2 vs 0.8%; OR, 1.48; 95% CI, 0.86-2.54; p = 0.15), but uncertainty remains.

Conclusions: UE in CICU patients is associated with greater odds of cardiac arrest, VAP, and MCS. Cardiac medical and surgical patients in the CICU appear to have different explanatory factors associated with UE, and perhaps these may be modifiable and tested in future collaborative population research.

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Conflict of interest statement

Dr. Schumacher disclosed that his institution houses the Pediatric Cardiac Critical Care Consortium (PC 4 ) data coordinating center, which is partially funded by the PC 4 consortium and that he is the director of the data coordinating center. Dr. Zhang disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

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