Unplanned Extubations in Pediatric Critical Care: A Case–Control Study

Abstract

The aim of this study was to quantify associations between the risk of unplanned extubation and patient-, environment-, and care-related factors in pediatric critical care and to compare outcomes between children who did and did not experience an unplanned extubation. This is a retrospective case–control analysis including patients <18 years who experienced an unplanned extubation during intensive care unit (ICU) admission (2004–2014). Cases were matched by age, duration of mechanical ventilation, and date to control patients (4:1) who were intubated but did not experience an unplanned extubation. Conditional logistic regression was used to evaluate associations between unplanned extubations and the abstracted characteristics. We identified 1,601 eligible controls matched to 458 case patients. When adjusted for confounders, eight variables were associated with unplanned extubation: three patient-related factors (previous ICU admission, previous intubation, and the volume of secretions); one environment-related factor (patient room setup); and four care-related factors (intubation route, and the use of sedation, muscle relaxation, and restraints). Patients who had an unplanned extubation had longer length of stay, but lower rate of mortality. This is the largest case–control study identifying variables associated with unplanned extubation in pediatric critical care. Several are potentially modifiable and may provide opportunities to improve quality of care in controlled ICU environments.

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“…The authors found on modeling that there were two associated explanatory factors: tube-related security and (in)adequacy of patient sedation. In 2022, the journal published a United States Virtual Pediatric Systems (LLC) database study of over 5,700 unplanned extubations in 149 PICUs (2012-2020) and explored associations with the need for reintubation (10). Patients with cardiovascular disease accounted for 14% of the population, but there was no subanalysis of this group.…”