Articles

Risk factors and outcomes of extubation failure in a South African tertiary paediatric intensive care unit

M-C F Kilba, S Salie, B M Morrow

Abstract


Background. Extubation failure contributes to poor outcome of mechanically ventilated children, yet the prevalence and risk factors have been poorly studied in South African (SA) children.
Objective. To determine the prevalence, risk factors and outcomes of extubation failure in an SA paediatric intensive care unit (PICU).
Methods. This was a prospective, observational study of all mechanically ventilated children admitted to a tertiary PICU in Cape Town, SA. Extubation failure was defined as requiring re-intubation within 48 hours of planned extubation.
Results. There were 219 episodes of mechanical ventilation in 204 children (median (interquartile range (IQR)) age 8 (1.6 - 44.4) months). Twenty-one of 184 (11.4%) planned extubations (95% confidence interval (CI) 7.2% - 16.9%) failed. Emergency cardiac admissions (adjusted odds ratio (aOR) 7.58 (95% CI 1.90 - 30.29), dysmorphology (aOR 4.90; 95% CI 1.49 - 16.14), prematurity (aOR 4.39; 95% CI 1.24 - 15.57), and ventilation≥48 hours (aOR 6.42 (95% CI 1.57 - 26.22) were associated with extubation failure. Children who failed extubation had longer durations of ventilation (231 hours (146.0 - 341.0) v. 53 hours (21.7 - 123.0);p<0.0001); longer duration of PICU (15 (9 - 20) days v. 5 (2 - 9) days;p<0.0001) and hospital length of stay (32 (21 - 53) days v. 15 (8 - 27) days;p=0.009); and higher 30-day mortality (28.6% v. 6.7%;p=0.001) than successfully extubated children.
Conclusions. Extubation failure was associated with significant morbidity and mortality in our setting. Risk factors for extubation failure identified in our context were similar to those reported in other settings.

Authors' affiliations

M-C F Kilba, Department of Paediatrics and Child Health, University of Cape Town, South Africa; Paediatric Intensive Care Unit, Greater Accra Regional Hospital, Ghana

S Salie, Department of Paediatrics and Child Health, University of Cape Town, South Africa; Paediatric Intensive Care Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

B M Morrow, Department of Paediatrics and Child Health, University of Cape Town, South Africa; Paediatric Intensive Care Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

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Cite this article

Southern African Journal of Critical Care 2022;38(1):26.

Article History

Date submitted: 2022-05-06
Date published: 2022-05-06

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