Incidence and Risk Factors for Cardiovascular Collapse After Unplanned Extubations in the Pediatric ICU

Abstract

BACKGROUND: Cardiovascular collapse is a life-threatening event after unplanned extubations (UEs) in the pediatric ICU (PICU). However, there is a paucity of pediatric studies assessing this complication. We sought to assess the incidence, risk factors, and outcome of cardiovascular collapse after UEs in PICU patients. METHODS: All children who had been mechanically ventilated for >= 12 h were prospectively tracked for UEs over an 8-y period. Subjects were included in the study if they were between ages 1 month and 16 y and had experienced UE. They were analyzed in 2 groups: those with cardiovascular collapse (defined as the need for cardiopulmonary resuscitation or circulatory dysfunction immediately after UE) and those with no cardiovascular collapse. RESULTS: Of the 847 subjects, 109 UEs occurred in 14,293 intubation days (0.76 UEs/100 intubation days), with 21 subjects (19.2%) experiencing cardiovascular collapse, of which 10 required cardiopulmonary resuscitation. Compared with subjects without cardiovascular collapse after UE, children with cardiovascular collapse were younger(<6 months old), with respiratory failure from lower respiratory tract diseases, lower P-aO2/F-IO2 (218 vs 282 mm Hg), and higher oxygenation indices (5.5 vs 3.5) before UE events. Logistic regression revealed that only an age <6 months old was strongly associated with cardiovascular collapse (odds ratio 3.4, P = .03). There were no differences between cardiovascular collapse and non-cardiovascular collapse subjects regarding the length of hospital stay, ventilator-associated pneumonia rate, and mortality. CONCLUSIONS: Cardiovascular collapse is a frequent complication of UEs, particularly in the youngest children. Specific bundles to prevent UEs may reduce morbidity related to these events.