Objective: To review a large population of children
receiving mechanical ventilation to establish a baseline rate of
extubation success and failure and to identify those characteristics
that place a patient at greater risk of failing planned
Design: Retrospective chart review.
Setting: University-affiliated children’s hospital with a
20-bed pediatric ICU.
Patients: All 632 patients
receiving mechanical ventilation during the 2-year period from July 1,
1996, to June 30, 1998.
Method: Patients receiving
mechanical ventilation were identified via a computerized database.
Charts were reviewed of all patients who were reintubated within
72 h of extubation.
Measurements and results:
There were 548 planned extubation events, of which 521 were successful.
Twenty-seven patients failed planned extubation at least once; only the
first attempt at extubation was included in the analysis. The failure
rate of planned extubations was 4.9%. Including only patients who had
received mechanical ventilation for > 24 h before extubation, the
failure rate was 6.0%. For patients intubated > 48 h, the failure
rate was 7.9%. The patients who failed extubation were found to be
significantly younger and to have received mechanical ventilation
longer than those who succeeded, in both the analysis of all patients
receiving mechanical ventilation and the subgroup of those receiving
mechanical ventilation > 24 h. When only patients who had received
mechanical ventilation for > 48 h were analyzed, the difference in
age was no longer significant, but the duration of ventilation before
extubation was still significantly longer for those who failed.
Conclusion: We determined the overall failure rate of
planned extubations in a large population of pediatric patients to be
4.9%. Those patients who were younger and had received mechanical
ventilation longer were more at risk for extubation