Predicting Reintubation After Unplanned Extubations in Children: Art or Science?

Silva, Paulo Sérgio Lucas da; Reis, Maria Eunice; Fonseca, Thais Suelotto Machado; Fonseca, Marcelo Cunio Machado

doi:10.1177/0885066616675130

Cited by 7 publications

(14 citation statements)

References 27 publications

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“…Furthermore, in a single-center case-control study of patients undergoing general surgical procedures, Rujirojindakul et al 20 reported that infants had a roughly 16-fold higher risk of UPI than young adults. In addition, da Silva et al 11 found that re-intubation rates in infants in the ICU (for surgical and nonsurgical conditions) were much higher than in children of other ages. While these studies all differ across a variety of patient demographics, study designs, surgical specialties, and even nonsurgical ICU patients, they all support our finding that young age places children at significantly increased risk for UPI.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies exploring the incidence and risk factors for unplanned postoperative intubation (UPI) were conducted in adult patients and are not specific to neurosurgical procedures 5–9 . Few pediatric studies have focused on children admitted to the ICU for various conditions (respiratory disorders, sepsis, trauma, and others) or on children undergoing cardiac surgery 10–13 . These patients have unique characteristics that limit the generalizability of these studies to specific patients presenting for craniotomy.…”

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confidence: 99%

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Factors Associated With Unplanned Post-Craniotomy Re-intubation in Children: A NSQIP-Pediatric® Analysis

Drapeau¹,

Mpody

Groß

et al. 2022

Journal of Neurosurgical Anesthesiology

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Objective: Most children undergoing craniotomy with general endotracheal anesthesia are extubated postoperatively, but some require unplanned postoperative intubation (UPI). We sought to determine the incidence of UPI and identify associated factors and related postoperative mortality. Methods:The National Surgical Quality Improvement Program for Pediatrics (2012)(2013)(2014)(2015)(2016)(2017)(2018) was used to retrospectively identify patients less than 18 years old who underwent craniotomy for epilepsy, tumor, and congenital/cyst procedures. Perioperative factors associated with UPI were identified with logistic regression models.Results: We identified 15,292 children, of whom 144 (0.94%) required UPI. Ninety-two (0.60%) children required UPI within the first 3 days after surgery. Postoperative mortality was higher among children with UPI within 3 days than in those with UPI later or not at all (8.0 vs. 2.2 vs. 0.3%, respectively; P <0.001). Posterior fossa procedures trended towards an increased odds of UPI (odds ratio [OR], 1.50; 95% confidence interval [CI] 0.99 to 2.27; P = 0.05). Five preoperative factors were independently associated with UPI: age ≤ 12 months (OR, 2.78; 95% CI, 1.29 to 5.98), ASA classification ≥ 3 (OR, 1.92; 95% CI, 1.12 to 3.29), emergent case status (OR, 2.06; 95% CI, 1.30 to 3.26), neuromuscular disease (OR, 1.87; 95% CI, 1.01 to 3.47), and steroid use within 30 days (OR, 1.79; 95% CI 1.14 to 2.79). Long operative times were independently associated with UPI (200 to 400 vs. <200 min OR, 1.92; 95% CI 1.18 to 3.11 and ≥ 400 vs. <200 min OR, 4.66; 95% CI 2.70 to 8.03). Conclusion:Although uncommon, UPI in children who underwent craniotomy was associated with an elevated risk of postoperative mortality. The presence of identifiable risk factors may be used for preoperative counseling and risk profiling in these patients.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Factors Associated With Unplanned Post-Craniotomy Re-intubation in Children: A NSQIP-Pediatric® Analysis

Drapeau¹,

Mpody

Groß

et al. 2022

Journal of Neurosurgical Anesthesiology

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“…Flexible bronchoscopy is becoming a more popular than rigid bronchoscopy to remove FBs [ 4 , 5 ]. Reintubation is a severe complication occurring in both flexible bronchoscopy and rigid bronchoscopy [ 6 ]. Reintubations lead to prolonged mechanical ventilator support, increased postoperative ICU admission, and a higher cost [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Reintubation is a severe complication occurring in both flexible bronchoscopy and rigid bronchoscopy [ 6 ]. Reintubations lead to prolonged mechanical ventilator support, increased postoperative ICU admission, and a higher cost [ 6 ]. Identifying and focusing on children with higher risks of reintubations are crucial.…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with reintubations in children undergoing foreign body removal using flexible bronchoscopy: a single-center retrospective cross-sectional study

Zhang

Zhou

et al. 2022

BMC Anesthesiol

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Background Reintubation is a severe complication during foreign body (FB) removal that uses flexible bronchoscopy. Objective To investigate the incidence and risk factors for reintubations in children undergoing FB extraction by flexible bronchoscopy in a single center. Design A retrospective cross-sectional study. Setting All children with foreign body aspiration at Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University from January 2015 to December 2020. Patients Children with FB removal using a flexible bronchoscopy were enrolled in the trial according to the inclusion criteria. Measurements Both multivariable and logistic regression analyses were used to analyze the association between characteristic data and reintubations. The results were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results In total, 244 patients met with the inclusion criteria and were included in the analysis. Among those participants, 28 children (11.5%) underwent reintubations after FB removal by flexible bronchoscopy. Independent factors associated with reintubations were identified as operative time ≥ 60 min [OR: 3.68, 95% CI (1.64–8.82)] and ASA ≥ III [OR: 5.7, 95% CI (1.23–26.4)]. Conclusions Children undergoing FB removal by a flexible bronchoscopy may encounter with a high incidence of postoperative reintubations. Both long operative duration and a severe physical status cause a growing risk of reintubations.

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“…Unplanned extubations in pediatric critical care require emergent, critical attention from clinicians to assess and support the patient’s respiration and ventilation. Reintubations after an unplanned extubation are associated with a higher risk of complications and a lower probability of success, when compared with a planned intubation in a controlled environment (1). Inserting the breathing tube multiple times increases the risk of airway injury, causing inflammation to the oropharynx or nasopharynx, larynx and trachea (2).…”

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confidence: 99%

Unplanned Extubations Requiring Reintubation in Pediatric Critical Care: An Epidemiological Study

Wollny¹,

McNeil

Moss

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES: Unplanned extubations are an infrequent but life-threatening adverse event in pediatric critical care. Due to the rarity of these events, previous studies have been small, limiting the generalizability of findings and the ability to detect associations. Our objectives were to describe unplanned extubations and explore predictors of unplanned extubation requiring reintubation in PICUs. DESIGN:Retrospective observational study and multilevel regression model. SETTING: PICUs participating in Virtual Pediatric Systems (LLC).PATIENTS: Patients (≤ 18 yr) who had an unplanned extubation in PICU (2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:We developed and trained a multilevel least absolute shrinkage and selection operator (LASSO) logistic regression model in the 2012-2016 sample that accounted for between-PICU variations as a random effect to predict reintubation after unplanned extubation. The remaining sample (2017-2020) was used to externally validate the model. Predictors included age, weight, sex, primary diagnosis, admission type, and readmission status. Model calibration and discriminatory performance were evaluated using Hosmer-Lemeshow goodness-of-fit (HL-GOF) and area under the receiver operating characteristic curve (AUROC), respectively. Of the 5,703 patients included, 1,661 (29.1%) required reintubation. Variables associated with increased risk of reintubation were age (< 2 yr; odds ratio [OR], 1.5; 95% CI, 1.1-1.9) and diagnosis (respiratory; OR, 1.3; 95% CI, 1.1-1.6). Scheduled admission was associated with decreased risk of reintubation (OR, 0.7; 95% CI, 0.6-0.9). With LASSO (lambda = 0.011), remaining variables were age, weight, diagnosis, and scheduled admission. The predictors resulted in AUROC of 0.59 (95% CI, 0.57-0.61); HL-GOF showed the model was well calibrated (p = 0.88). The model performed similarly in external validation (AUROC, 0.58; 95% CI, 0.56-0.61). CONCLUSIONS:Predictors associated with increased risk of reintubation included age and respiratory primary diagnosis. Including clinical factors (e.g., oxygen and ventilatory requirements at the time of unplanned extubation) in the model may increase predictive ability.

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Predicting Reintubation After Unplanned Extubations in Children: Art or Science?

Abstract: The rate of reintubation is high in children experiencing UE. Requirement of full ventilator support and a COMFORT score <26 are associated with reintubation. Prospective research is required to better understand the reintubation decisions and needs.

Cited by 7 publications

References 27 publications

Factors Associated With Unplanned Post-Craniotomy Re-intubation in Children: A NSQIP-Pediatric® Analysis

Factors Associated With Unplanned Post-Craniotomy Re-intubation in Children: A NSQIP-Pediatric® Analysis

Risk factors associated with reintubations in children undergoing foreign body removal using flexible bronchoscopy: a single-center retrospective cross-sectional study

Unplanned Extubations Requiring Reintubation in Pediatric Critical Care: An Epidemiological Study

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