341: Success of respiratory rescue therapy in preventing reintubation in a pediatric intensive care unit.

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Critical Care Medicine


Introduction/Hypothesis: Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity and mortality. Data comparing the various modes of oxygen delivery and respiratory rescue (RR) therapy following extubation in preventing reintubation in this population is lacking. The objective of this study was to compare RR therapy modalities following extubation from mechanical ventilation. Methods: Retrospective review of pediatric patients, ages 18 and under, admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017. Base-line demographics, reason and length of intubation, use of RR modalities, need for reintubation, 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 reviewed with most patients intu-bated for respiratory failure (34.5%), surgery (34.3%), or al-tered mental status (31.5%). PIM2 severity of illness was similar across all treatment groups indicating similar severity of illness. 7.9% of patients required RR therapy after extubation, of which 22.5% failed and required reintubation. Patients initially extubated to nasal cannula who required RR therapy with high-flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NIPPV) successfully avoided reintubation 71.4% and 86.7% of the time, respectively. There was no significant difference in avoiding reintubation by use of HFNC versus NIPPV (p = 0.39). Patients who required RR therapy had longer PICU LOS (11.1 v 6.9 days, p = 0.0083) and hospital LOS (16.2 vs 10.2 days, p = 0.0218).Conclusions: Mechanically ventilated pediatric patients who re-quire RR therapy following initial extubation in the PICU can avoid reintubation a majority of the time with the use of HFNC or NIPPV; although, no modality appears superior to another. Those who did require RR therapy experience a statistically significant longer PICU and hospital LOS. Further prospective clinical trials in the treatment of this at-risk population are warranted.





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