Prevalence of extubation failure and associated factors among pediatric patients admitted to the Pediatric Intensive Care Unit at Tikur Anbessa Specialized Hospital, Ethiopia

Abstract

Introduction: A critical component of pediatric intensive care therapy is mechanical ventilation which used when the patient’s spontaneous breathing is inadequate. In the pediatric intensive care unit, the need for mechanical ventilation ranges from 20% to over 60%, depending on the setting. Respiratory failure is the primary indication for the initiation of ventilator support in pediatric patients as a result of airway or lung disease, multiorgan failure or postoperative care.

Objective: Assessing the prevalence and factors associated with extubation failure among pediatric patients (0-14 years) admitted to the pediatric intensive care unit at Tikur Anbessa Specialized Hospital.

Methods: A facility-based cross-sectional study was conducted among 155 pediatric patients admitted to the pediatric intensive care unit during September 2019 to September 2023. Data were collected using a checklist, entered into Epi-info software, exported to SPSS version 25, and analyzed. Multivariate logistic regression identified factors associated with extubation failure. Variables with P values < 0.05 were considered statistically significant. Hosmer and Leme’s goodness-of-fit test assessed model fitness. The adjusted odds ratio with the 95% confidence interval measured the association strength between outcome and independent variables.

Results: A total of 18.1% of intubated and extubated patients experienced extubation failure (95% CI: 12.9–24.5). Patients with hospital stays exceeding 30 days had significantly higher odds of extubation failure (AOR = 2.81, 95% CI: 5.23–15.60), as did those with hospital stays of 10–30 days (AOR = 2.31, 95% CI: 3.10–17.76). Additionally, the likelihood of extubation failure was 2.14 times higher for patients who were not nebulized immediately after extubation compared to those who were nebulized (AOR = 2.14, 95% CI: 5.87–9.46). 

Conclusion: This study revealed that the extubation failure rate was 18.1%. Prolonged hospital stays and failure to nebulize after extubation were found to be determinants of extubation failure.