Extubation failure in a large pediatric ICU population

Objective: To review a large population of children receiving mechanical ve ntilation to establish a baseline rate of extubation success and failure ac id to identify those characteristics that place a patient at greater risk o f 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-ye ar period from July 1, 1996, to June 30, 1998. Method: Patients receiving m echanical ventilation were identified via a computerized database. Charts w ere reviewed of all patients who were reintubated within h of extubation. Measurements and results: There were 548 planned extubation events, of whic h 521 were successful. Twenty-seven patients failed planned extubation at l east once; only the first attempt at extubation was included in the anal,si s. The failure rate of planned extubations was 4.9%. Including only patient s 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 he significantly yo unger and to have received mechanical ventilation longer than thr,se who su cceeded, in both the analysis of all patients receiving mechanical ventilat ion and the subgroup of those receiving mechanical ventilation > 24 h. When only patients who had received mechanical ventilation for > 48 h were anal yzed, the difference in age was no longer significant, but the duration of ventilation before extubation nas still significantly longer for those who failed. Conclusion: We determined the overall failure rate of planned extubations i n a large population of pediatric patients to be 4.9% Those patients who we re younger and had received mechanical ventilation longer were more at risk for extubation failure.