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Extubation Failure: The reality of a Pediatric Intensive Care Unit

Vanessa Gorito, Sofia Vasconcelos, Marta João Silva, Amélia Moreira, Teresa Cunha da Mota, Augusto Ribeiro.

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Extubation failure (EF) is characterized by the need for reintubation after removal of the endotracheal tube. The prevalence in pediatric age is estimated at 2-20%. Although the causes are almost always multifactorial, EF has been associated with several risk factors and is generally associated with a worse prognosis and higher morbidity. We aimed to characterize the patients with EF admitted to the Pediatric Intensive Care Unit (PICU) of a Tertiary Hospital. It was performed a retrospective descriptive study of EF cases, considering all children admitted to the PICU between January 2017 and June 2020. Our study showed that patients with EF are mostly male and under the age of 2 years, with surgical admission, congenital heart disease, a higher LOS in PICU (12.5 days vs 5.6 days) and mortality (9.0% vs 2.67%). The presence of stridor was more prevalent in EF patients (45.4% vs 8.9%), probably increasing the risk of EF. Peri-extubation corticosteroids used in 72.7% of the EF patients seem to justify in part the existence of stridor after extubation (10.3% of all extubated patients vs 45.4% in EF patients). The higher use of corticosteroids in EF patients (72.7% vs 57.5%) is in line with higher stridor incidence among EF patients. Patients with EF have a higher length of stay, more comorbidities, more sequelae and generally worse prognosis. The adequate characterization of these patients makes it possible to plan and develop multidisciplinary strategies to prevent and minimize the risk factors associated with EF.

Key words: extubation failure, pediatric intensive care, morbidity, mortality, risk factor

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