Extubation failure in pediatric subjects after liver transplantation
Abstract
Objective: To determine the extubation failure (EF) rate, and identify possible associated factors, in pediatric subjects who were admitted to the intensive care unit (ICU) and required invasive mechanical ventilation (IMV) after liver transplantation.
Materials and method: An observational, descriptive and retrospective study was conducted. Subjects aged under 18 years, extubated after liver transplantation in the polyvalent ICU between January 1, 2006, and December 31, 2009, were included in the study. Subjects who were extubated to preventive noninvasive ventilation (NIV) were excluded.
Results: Of 52 extubated subjects, 11 (21.1%) failed and required reintubation. The duration of IMV, surgical reinterventions, and muscle weakness at endotracheal extubation were significantly associated with reintubation (p=0.02, p=0.05, and p=0.04, respectively). The reasons for reintubation were muscle fatigue (n=6), hemodynamic instability (n=1), and other causes, such as upper airway obstruction, poor respiratory drive, and readmission to the operating room (n=4).
Conclusion: The EF rate was 21.1%. The duration of IMV, surgical reinterventions, and diaphragmatic weakness were identified as associated factors. The use of NIV to avoid reintubation could be beneficial to improve the work of breathing in these subjects. To correctly identify the risk factors for EF, a multivariate analysis would be required.
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