Extubation Failure and Timing to Tracheostomy in Children Surviving Acute Neurological Injury
<b>Background/Objectives</b>: Critically ill patients with acute neurological injury commonly require intubation. The true incidence of and risk for extubation failure in pediatric patients with an acute neurologic injury is not well reported, making the assessment of these patients for...
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MDPI AG
2025-04-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/12/5/586 |
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| author | Ethan L. Gillett Sneha Jayadeep Chary Akmyradov Salim Aljabari |
| author_facet | Ethan L. Gillett Sneha Jayadeep Chary Akmyradov Salim Aljabari |
| author_sort | Ethan L. Gillett |
| collection | DOAJ |
| description | <b>Background/Objectives</b>: Critically ill patients with acute neurological injury commonly require intubation. The true incidence of and risk for extubation failure in pediatric patients with an acute neurologic injury is not well reported, making the assessment of these patients for extubation readiness or the need for tracheostomy challenging. This study aims to better delineate the incidence of extubation failure and factors associated with the need for tracheostomy in pediatric patients surviving an acute neurologic injury. <b>Methods</b>: We conducted a retrospective cohort study using the Virtual Pediatric System (VPS) database of neonates, infants, children, and adolescents < 18 years of age with a neurological injury requiring intubation from 2012 to 2022. Demographic and clinical variables were compared between subjects that were successfully extubated, those with early tracheostomy placement (≤14 days), and those with late tracheostomy placement (>14 days). <b>Results</b>: Of the 38,810 enrolled subjects, 37,661 (97.04%) were successfully extubated, 481 (1.24%) underwent early tracheostomy, and 668 (1.72%) underwent late tracheostomy. The most common etiologies were seizures (60.6%), trauma (20.9%), and intoxication (9.1%). The successfully extubated subjects had a higher median initial GCS score (8 vs. 5 and 4, <i>p</i> < 0.001) and fewer extubation attempts (1 vs. 3 and 3, <i>p</i> < 0.001) than the tracheostomy cohorts. There was a significant difference in median ICU days between the three groups (2.52 vs. 18.3 vs. 38.3, <i>p</i> < 0.001). <b>Conclusions</b>: The majority of pediatric patients requiring intubation following an acute neurological injury can be successfully extubated. Among patients requiring a tracheostomy, those who received it early had significantly shorter ICU and hospital stays. |
| format | Article |
| id | doaj-art-b87f55c6713841dbb16b92f62fa1fb40 |
| institution | OA Journals |
| issn | 2227-9067 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj-art-b87f55c6713841dbb16b92f62fa1fb402025-08-20T01:56:25ZengMDPI AGChildren2227-90672025-04-0112558610.3390/children12050586Extubation Failure and Timing to Tracheostomy in Children Surviving Acute Neurological InjuryEthan L. Gillett0Sneha Jayadeep1Chary Akmyradov2Salim Aljabari3Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Science, Little Rock, AR 72205, USADepartment of Internal Medicine, College of Medicine, University of Arkansas for Medical Science, Little Rock, AR 72205, USAArkansas Children’s Hospital, Little Rock, AR 72205, USADepartment of Internal Medicine, College of Medicine, University of Arkansas for Medical Science, Little Rock, AR 72205, USA<b>Background/Objectives</b>: Critically ill patients with acute neurological injury commonly require intubation. The true incidence of and risk for extubation failure in pediatric patients with an acute neurologic injury is not well reported, making the assessment of these patients for extubation readiness or the need for tracheostomy challenging. This study aims to better delineate the incidence of extubation failure and factors associated with the need for tracheostomy in pediatric patients surviving an acute neurologic injury. <b>Methods</b>: We conducted a retrospective cohort study using the Virtual Pediatric System (VPS) database of neonates, infants, children, and adolescents < 18 years of age with a neurological injury requiring intubation from 2012 to 2022. Demographic and clinical variables were compared between subjects that were successfully extubated, those with early tracheostomy placement (≤14 days), and those with late tracheostomy placement (>14 days). <b>Results</b>: Of the 38,810 enrolled subjects, 37,661 (97.04%) were successfully extubated, 481 (1.24%) underwent early tracheostomy, and 668 (1.72%) underwent late tracheostomy. The most common etiologies were seizures (60.6%), trauma (20.9%), and intoxication (9.1%). The successfully extubated subjects had a higher median initial GCS score (8 vs. 5 and 4, <i>p</i> < 0.001) and fewer extubation attempts (1 vs. 3 and 3, <i>p</i> < 0.001) than the tracheostomy cohorts. There was a significant difference in median ICU days between the three groups (2.52 vs. 18.3 vs. 38.3, <i>p</i> < 0.001). <b>Conclusions</b>: The majority of pediatric patients requiring intubation following an acute neurological injury can be successfully extubated. Among patients requiring a tracheostomy, those who received it early had significantly shorter ICU and hospital stays.https://www.mdpi.com/2227-9067/12/5/586extubationneurologic injuryneurocritical caretracheostomypediatrics |
| spellingShingle | Ethan L. Gillett Sneha Jayadeep Chary Akmyradov Salim Aljabari Extubation Failure and Timing to Tracheostomy in Children Surviving Acute Neurological Injury Children extubation neurologic injury neurocritical care tracheostomy pediatrics |
| title | Extubation Failure and Timing to Tracheostomy in Children Surviving Acute Neurological Injury |
| title_full | Extubation Failure and Timing to Tracheostomy in Children Surviving Acute Neurological Injury |
| title_fullStr | Extubation Failure and Timing to Tracheostomy in Children Surviving Acute Neurological Injury |
| title_full_unstemmed | Extubation Failure and Timing to Tracheostomy in Children Surviving Acute Neurological Injury |
| title_short | Extubation Failure and Timing to Tracheostomy in Children Surviving Acute Neurological Injury |
| title_sort | extubation failure and timing to tracheostomy in children surviving acute neurological injury |
| topic | extubation neurologic injury neurocritical care tracheostomy pediatrics |
| url | https://www.mdpi.com/2227-9067/12/5/586 |
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