Análise da taxa de falha de extubação e fatores de risco em uma unidade de terapia intensiva pediátrica.

Abstract

The objective of the study was to verify the extubation failure rate, the main risk factors associated with failure, and its causes in a Pediatric Intensive Care Unit (PICU). This was a retrospective cohort study. Data were collected on age, admission diagnosis, length of stay, sedation time, duration of invasive mechanical ventilation (IMV), use of non-invasive ventilation (NIV) post-extubation, corticosteroid use, and risk factors for extubation failure of patients who required intubation during the period from January to December 2022. Data collection was done through a spreadsheet of clinical indicators and electronic medical records. Statistical analysis was conducted descriptively and inferentially. Quantitative variables were presented using the median, and categorical variables were presented using absolute frequency and percentages. Comparisons between the extubation failure and successful group were made using the chi-square test and Kruskal-Wallis, and the influence of variables on extubation failure was analyzed using logistic regression. The significance level was 5%. The failure rate found in this study was 11.24%. The IMV for more than 48 hours and the use of an inspired fraction of oxygen (FiO2) above 50% were the main risk factors associated with extubation failure. Length of stay, sedation time, IMV duration, endotracheal tube (ETT) exchange, and especially IMV > 48 hours influenced an increased risk of failure. The use of NIV post-extubation did not reduce extubation failure. The main causes of unsuccessful extubation were, respectively, desaturation, respiratory discomfort, and laryngeal stridor. It is concluded that the failure rate was within the values described in the literature. IMV > 48 hours was the risk factor most associated with and significantly influenced extubation failure. The main cause of failure was desaturation.