Peri-extubation practices and extubation failure in a South African tertiary paediatric intensive care unit

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dc.contributor.advisorSalie, Shamiel
dc.contributor.advisorMorrow, Brenda
dc.contributor.authorKilba, Marie-Charlyne Fatima
dc.date.accessioned2019-05-10T12:08:09Z
dc.date.available2019-05-10T12:08:09Z
dc.date.issued2018
dc.date.updated2019-05-07T09:27:57Z
dc.description.abstractObjectives To describe the peri-extubation practices in a South African paediatric intensive care unit and to determine the prevalence, risk factors and outcomes of extubation failure. Design Prospective observational study. Setting A multi-disciplinary paediatric intensive care unit in Cape Town, South Africa. Patients All intubated and ventilated patients between May and September 2017. Interventions There were no research- related interventions Measurements and Main Results Extubation failure was defined as requiring re-intubation within 48 hours of planned extubation. Two hundred and sixteen intubations in 204 children, with a median age of 8 months (IQR 1.6 – 44.4) and median PIM3 risk of mortality score 0.03 (IQR 0.01 – 0.07) were included. There were 184 planned extubations; 21 (10.3%) patients died before extubation; two (1%) had tracheostomies; two (1%) were transferred intubated and seven (3.4%) had ventilation withdrawn. Non-invasive ventilation was implemented in 97 cases (52.7%) after planned extubation. There were 21 (11.4%) failed extubations. Indications for re-intubation were: upper airway obstruction (n=7; 33.3%); respiratory failure (n=4; 19.0%); heart failure (n=3; 14.3%); diaphragm paralysis, hypoventilation and cardiac arrest (n=2; 9.5% each); and reduced level of consciousness (n=1; 4.8%). Prematurity (adjusted OR 1.8 (95% CI 0.05 – 0.6); p =0.004), dysmorphology (OR 1.8 (95% CI 0.05 – 0.6); p=0.022), decreased level of consciousness (OR 4.8 (95% CI 1.96 – 11.7); p=0.001) and ventilation ≥48 hours (OR 0.2 (95% CI 0.05 – 0.7); p = 0.003) were independently associated with extubation failure on multivariate analysis. Children who failed extubation had longer duration of ventilation (median 231 versus 53 hours; p < 0.0001), PICU length of stay (median 15 versus 5 days; p < 0.0001) and hospital length of stay (32 versus 15 days; p=0.009); and higher mortality (28.6% versus 6.7%; p = 0.001) compared to those successfully extubated. Conclusion Extubation failure is associated with significant morbidity and mortality. Independent risk factors of extubation failure identified in our context were prematurity, dysmorphology, impaired consciousness and ventilation for more than 48 hours.
dc.identifier.apacitationKilba, M. F. (2018). <i>Peri-extubation practices and extubation failure in a South African tertiary paediatric intensive care unit</i>. (). ,Faculty of Health Sciences ,Department of Paediatrics and Child Health. Retrieved from http://hdl.handle.net/11427/30051en_ZA
dc.identifier.chicagocitationKilba, Marie-Charlyne Fatima. <i>"Peri-extubation practices and extubation failure in a South African tertiary paediatric intensive care unit."</i> ., ,Faculty of Health Sciences ,Department of Paediatrics and Child Health, 2018. http://hdl.handle.net/11427/30051en_ZA
dc.identifier.citationKilba, M.F. 2018. Peri-extubation practices and extubation failure in a South African tertiary paediatric intensive care unit. . ,Faculty of Health Sciences ,Department of Paediatrics and Child Health. http://hdl.handle.net/11427/30051en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Kilba, Marie-Charlyne Fatima AB - Objectives To describe the peri-extubation practices in a South African paediatric intensive care unit and to determine the prevalence, risk factors and outcomes of extubation failure. Design Prospective observational study. Setting A multi-disciplinary paediatric intensive care unit in Cape Town, South Africa. Patients All intubated and ventilated patients between May and September 2017. Interventions There were no research- related interventions Measurements and Main Results Extubation failure was defined as requiring re-intubation within 48 hours of planned extubation. Two hundred and sixteen intubations in 204 children, with a median age of 8 months (IQR 1.6 – 44.4) and median PIM3 risk of mortality score 0.03 (IQR 0.01 – 0.07) were included. There were 184 planned extubations; 21 (10.3%) patients died before extubation; two (1%) had tracheostomies; two (1%) were transferred intubated and seven (3.4%) had ventilation withdrawn. Non-invasive ventilation was implemented in 97 cases (52.7%) after planned extubation. There were 21 (11.4%) failed extubations. Indications for re-intubation were: upper airway obstruction (n=7; 33.3%); respiratory failure (n=4; 19.0%); heart failure (n=3; 14.3%); diaphragm paralysis, hypoventilation and cardiac arrest (n=2; 9.5% each); and reduced level of consciousness (n=1; 4.8%). Prematurity (adjusted OR 1.8 (95% CI 0.05 – 0.6); p =0.004), dysmorphology (OR 1.8 (95% CI 0.05 – 0.6); p=0.022), decreased level of consciousness (OR 4.8 (95% CI 1.96 – 11.7); p=0.001) and ventilation ≥48 hours (OR 0.2 (95% CI 0.05 – 0.7); p = 0.003) were independently associated with extubation failure on multivariate analysis. Children who failed extubation had longer duration of ventilation (median 231 versus 53 hours; p < 0.0001), PICU length of stay (median 15 versus 5 days; p < 0.0001) and hospital length of stay (32 versus 15 days; p=0.009); and higher mortality (28.6% versus 6.7%; p = 0.001) compared to those successfully extubated. Conclusion Extubation failure is associated with significant morbidity and mortality. Independent risk factors of extubation failure identified in our context were prematurity, dysmorphology, impaired consciousness and ventilation for more than 48 hours. DA - 2018 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PY - 2018 T1 - Peri-extubation practices and extubation failure in a South African tertiary paediatric intensive care unit TI - Peri-extubation practices and extubation failure in a South African tertiary paediatric intensive care unit UR - http://hdl.handle.net/11427/30051 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/30051
dc.identifier.vancouvercitationKilba MF. Peri-extubation practices and extubation failure in a South African tertiary paediatric intensive care unit. []. ,Faculty of Health Sciences ,Department of Paediatrics and Child Health, 2018 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/30051en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Paediatrics and Child Health
dc.publisher.facultyFaculty of Health Sciences
dc.titlePeri-extubation practices and extubation failure in a South African tertiary paediatric intensive care unit
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMPhil (Paediatric Critical Care)
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