Risk factors for pediatric postextubation stridor at Maharat Nakhon Ratchasima Hospital
Keywords:
omplications, extubation failure, endotracheal tubeAbstract
Background: Postextubation stridor (PES) is one of the most common immediate complications of extubation. PES accounts for one-third of extubation failures, leading to reintubation, which also increases the risk of pneumonia, length of hospital stay, and mortality. Pediatric PES research in Thailand is still limited.
Objective: To identify risk factors for PES in the pediatric intensive care unit (PICU) at Maharat Nakhon Ratchasima Hospital.
Methods: Prospective cohort study was conducted. The intubated patients aged 29 days to 15 years who were admitted to PICU between January 1st and November 30th, 2020, received mechanical ventilators for at least 12 hours, and were also extubated in PICU. The baseline characteristics and clinical course of the patients were collected until they were discharged from the hospital or died and analyzed by multiple logistic regression.
Results: The 386 patients were admitted to the PICU. Eligible participants were 251 patients, and finally 134 patients were enrolled. There were 82 males (61.2%), with a median age of 1 year and 9 months. A total of 62 patients had an underlying disease (46.3%). The causes of intubation were medical conditions which accounted for 104 patients (77.6%) and surgical conditions accounted for 30 patients (22.4%). The prevalence of PES was 37.3 percent. The statistically significant risk factors for PES were age, and endotracheal tube size. The risk of PES decreases with age. (OR 0.81, 95%CI 0.68-0.95, p-value 0.01) When comparing proper size to unsuitable size, the risk of PES is 7.6 (OR 7.6, 95%CI 2.23-25.59, p-value <0.01) and 10.4 times (OR 10.4, 95%CI 2.4-44.81, p-value <0.01) higher in the smaller and larger size groups, respectively.
Conclusion: The prevalence of PES was 37.3 percent. Young age, and improper endotracheal tube size were the significant risk factors for PES.
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