Extubation Failure in Pediatric Critical Care: A Secondary Analysis of the 2018–2019 Sedation and Weaning in Children (SandWiCh) Trial

Objectives: Extubation failure is defined as requirement for emergency reintubation within 48 hours of extubation. We aimed to examine the rate of extubation failure in a large U.K. dataset, including an examination of the prevalence of postextubation stridor, and to determine which patient factors were associated with failure. Design: A post hoc, non–prespecified secondary analysis of the 2018–2019 Sedation and Weaning in Children clinical (SandWiCh) cluster-randomized trial (ISRCTN16998143) dataset. Setting: The SandWiCh trial recruited patients from 18 U.K. PICUs. Patients: All patients with data for a planned extubation were included and patients who had an unplanned extubation, or who died following their first extubation without being reintubated were excluded. Interventions: None. Measurements and Main Results: Data for 9215 patients in the trial with at least one planned extubation attempt were available for analysis. The factors associated with for extubation failure being examined included age, diagnostic group, severity of illness at PICU admission, and duration of mechanical ventilation before extubation. Extubation failure occurred following first planned extubation in 618 of 9215 (6.7%). On multivariable analysis, Pediatric Index of Mortality (PIM-3) score and duration of ventilation before extubation attempt were associated with greater odds of extubation failure. Of the entire cohort, 874 children (9.4%) had postextubation stridor, but this figure rose to 173 of 618 patients (28%) who had extubation failure. Conclusions: In the 2018–2019 SandWiCh dataset from the United Kingdom, failed extubation rate was comparable to other published cohorts. Greater odds of failed extubation was associated with increased PIM-3 score and duration of mechanical ventilation before attempted extubation. Stridor was present in a quarter of patients with extubation failure.