Risk Factors of Unplanned Extubation in Pediatric Intensive Care Unit

BACKGROUND: Unplanned extubation (UE) is an unprecedented happening in pediatric intensive care unit (PICU); which may lead to severe complications in patients. The risk factors of UE have been discussed but much details are still required in this regard. This study aimed to evaluate predisposing and risk factors of unplanned extubation in PICU. MATERIALS AND METHODS: Patients intubated in PICU who had UE were compared to a control group without UE in a retrospective study. Fifty-nine patients with UE matched with 180 controls were enrolled. Factors including age, gender, use of cuffed endotracheal tube (ETT), duration of intubation, patient agitation, and ETT fixation method were analyzed. RESULTS: A total of 59 UEs occurred in 239 intubated patients in a total of 1631 intubated patient-day. This represents UE incidence rate of 1.95% per patientday and 3.6% per intubated patient-day. In multivariate analysis, risk factors for UE included age younger than 2 years (OR: 1.34, 95% CI: 1.13-3.61, P = 0.001), male gender (OR: 2.53, 95% CI: 1.35-4.23, P = 0.005), agitation (OR: 1.83, 95% CI: 1.54-5.36, P = 0.001), high saliva secretion (OR: 4.42, 95% CI: 2.35-5.45, P = 0.007), and duration of intubation (OR 1.39, 95% CI: 1.22-2.58, P = 0.01). CONCLUSION: Unplanned extubation can be a catastrophic incident if enough attention is not paid to the patients at risk in PICU. These risk factors are age younger than 2, male gender, agitation, high salivary secretion and duration of intubation.