Abstract
Objective: This study aimed to analyze the demographic, clinical, and ventilatory variables associated with extubation failure in pediatric intensive care patients.
Methods: A retrospective observational study was conducted at King Salman Medical City Hospital, Medina, Saudi Arabia, involving 35 pediatric patients (aged 1 month to 14 years) who underwent extubation after mechanical ventilation. Data collection relied on reviewing paper-based and electronic medical records, using standardized forms to extract relevant information. Data were collected on patient demographics, medical history, cause of pediatric intensive care admission, ventilatory parameters, and post-extubation outcomes.
Results: The majority of patients were infants (n = 21, 60.0%), where most had hemoglobin levels below 10 g/ dl (n = 26, 74.3%). Pre-existing syndromic/genetic disorders were present in 15 patients (42.9%), neurological conditions in 13 patients (37.1%), and pre-existing respiratory conditions in three patients (8.6%). Despite thorough pre-extubation preparation, all patients experienced extubation failure (n = 35, 100.0%). Respiratory insufficiency was the primary cause of reintubation (n = 26, 74.3%), followed by neurological causes (n = 6, 17.1%). Nearly all patients were ventilated with tidal volumes of 5-10 ml/kg and positive end-expiratory pressure of 5-10 cm H2O (n = 34, 97.1%). The average time for reintubation was 45.29 hours.
Conclusion: Respiratory insufficiency and neurological factors were significant contributors to extubation failure in pediatric patients. Optimizing ventilatory settings and conducting thorough pre-extubation evaluations, especially in high-risk populations, are crucial. Future research should focus on multi-center studies to explore additional risk factors and potential interventions like non-invasive respiratory support to improve extubation success and reduce reintubation rates in pediatric ICUs.

Key words: Extubation failure, pediatric intensive care unit, respiratory insufficiency, mechanical ventilation, reintubation