Prediction of extubation failure in newborns, infants and children: brief report of a prospective (blinded) cohort study at a tertiary care paediatric centre in India

BACKGROUND Extubation failure (EF), defined as need for re-intubation within 24-72 h, is multifactorial. Factors predicting EF in adults generally are not useful in children. OBJECTIVE To determine the factors associated with EF and to facilitate prediction of EF in mechanically ventilated infants and children less than 12 years of age. MATERIAL AND  METHODS Design Prospective cohort study. Setting PICU and NICU of a multispecialty tertiary care institute. Patients All consecutive newborns, infants and children, who remained on the ventilator for more than 12 h, were included. Patients with upper airway obstruction, neuromuscular disorders, complex anatomic malformations, accidental extubation, tracheostomy or death before extubation were excluded. Methods The pre-extubation clinical, laboratory and ventilatory parameters were collected for 92 cases over a one and half year period. The EF rate was calculated for each variable using STATA 9. All the treating physicians were blinded to the data collection procedure. MEASUREMENTS AND RESULTS Demographics were comparable between the extubation success and EF groups. Respiratory failure was the main cause requiring ventilation (46.74 %, 95 % CI 0.37-0.57) as well as EF (30.23 %, 95 % CI 0.08-0.23). 76.92 % (95 % CI 0.58-0.89) of patients that failed extubation had alterations in respiratory effort, 38.46 % (95 % CI 0.22-0.57) each had either poor or increased respiratory effort. Poor cough reflex (p = 0.001), thick endotracheal secretions (p = 0.02), failed spontaneous breathing trial (SBT) (p = 0.001) and higher rapid shallow breathing index (RSBI) (p = 0.001) were found to be associated with EF. CONCLUSIONS Paediatric EF is multifactorial. Increased or poor respiratory effort and failed SBT are potential factors in deciding re-intubation. Increased RSBI, poor cough reflex and thick.