360: Impact of reintubation and use of respiratory rescue therapy in the pediatric intensive care unit

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Critical Care Medicine


Introduction/Hypothesis: Patients admitted to the Pediatric Intensive Care Unit (PICU) who require mechanical ventilation often experience prolonged care with increased morbidity and mortality. The objective of this study was to identify patients requiring mechanical ventilation at greater risk for prolonged care and mortality.Methods: A retrospective review of pediatric patients admitted to a single center PICU requiring mechanical ventilation from January 2010 through December 2017 was performed. Patient admitting diagnoses, reason for intubation, length of intubation, use of respiratory rescue (RR) therapy, reintubation rates, and PICU and hospital length of stay (LOS) were analyzed. T-Tests and Chi-Square tests were used for continuous and categorical variables, respectively.Results: 502 patients were included in the study with a median age of 66.5 months (IQR 7.0- 166.0). Median PICU LOS was 4 days (IQR 2-9) and median overall LOS was 6 days (IQR 3-14). Most patients were intubated for respiratory failure (34.5%), surgery (34.3%), or altered mental status (31.5%) with a median intubation time of 15.3 hours (IQR 6.1-42.4). 7.96% of patients required RR therapy after extubation, while 5.58% of patients required reintubation. Patients who required RR therapy had longer PICU LOS (11.08 vs 6.96 days, p = 0.0083) and hospital LOS (16.2 vs 10.2 days, p = 0.0218). Similarly, patients who required reintubation also had longer PICU LOS (21.3 days vs 6.5 days, p = 0.0002), hospital LOS (24.3 days vs 9.9 days, p = 0.0003), and increased mortality (7.14% vs 0.63%, OR 12.5; p = 0.0066). Patients who required reintubation were younger (41.4 months vs 86.5 months, p = 0.0003) and more likely to have required initial intubation for respiratory failure (11% vs 2.7%, OR 4.25; p = 0.0004).Conclusions: Pediatric patients who need RR therapy or reintubation require prolonged care, and those requiring reintubation also have greater risk of mortality. Younger patients and those with respiratory failure as their indication for support are more likely to fall into this high-risk category. This data can help guide resource utilization and physicians in their approach to critically ill patients.





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