Contemporary Trends in Pediatric Extubation Failure and Noninvasive Respiratory Support Use

Published in Chest. Here is a link to the article.

Regenstrief Institute author: Colin Rogerson, MD, MPH

Prolonged invasive mechanical ventilation (IMV) in children increases morbidity, making timely extubation essential. This study analyzed 132,712 pediatric IMV encounters from 2013–2022 across 158 North American ICUs to assess extubation failure (EF), postextubation noninvasive support, and outcomes. Overall EF was 8.5%, decreasing slightly over time (≤48 hours: 8.9% to 8.1%; ≤7 days: 12.3% to 11.0%), while noninvasive support nearly doubled (20.9% to 39.9%). Higher EF risk was seen in younger patients (<6 weeks: OR 1.39; 6 weeks–12 months: OR 1.24), those with renal (OR 1.25), respiratory (OR 1.15), or cardiac diagnoses (OR 1.10), and patients receiving ≥7 days of IMV (OR 1.26). EF rates were unchanged in low-risk children (0–1 risk factor). EF was linked to longer ventilation (11.6 vs 4.0 days), ICU stay (18.8 vs 7.9 days), and hospital stay (31.0 vs 15.0 days), but not mortality (8.5% vs 8.6%).

Over the last decade, increased postextubation noninvasive support corresponded with modest EF reductions, benefiting high-risk patients. However, its rising use in low-risk groups may represent overutilization. EF prolongs care and hospitalization but does not increase mortality, emphasizing the need for targeted postextubation strategies in pediatric critical care.

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