Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Respiratory Therapy, Children's Hospital of Alabama, Birmingham, Alabama.
Respir Care. 2021 May;66(5):777-784. doi: 10.4187/respcare.08494. Epub 2021 Feb 9.
The majority of pediatric extubations occur during day shift hours. There is a time-dependent relationship between mechanical ventilation duration and complications. It is not known if extubation shift (day vs night) correlates with pediatric extubation outcomes. Pediatric ventilation duration may be unnecessarily prolonged if extubation is routinely delayed until day shift hours.
We hypothesized that extubation failure would not correlate with shift of extubation and that ventilation duration at first extubation and that length of stay in the pediatric ICU (PICU) would be shorter for children extubated at night. This was a retrospective cohort study within one tertiary care, 24-bed, academic PICU.
582 ventilation encounters were included, representing 517 unique subjects. Status epilepticus was a more common diagnosis among night shift extubations ( = .005), whereas surgical airway conditions were more common among day shift extubations ( = .02). Mechanical ventilation duration at first extubation (37.6 vs 62.5 h, < .001) and length of stay in the PICU (2.8 vs 4.5 d, < .001) were shorter for night shift extubations. The extubation failure rate was 10.3% for day shift and 8.1% for night shift ( = .40). Logistic regression modeling at the level of the unique subject indicated that extubation shift was not associated with extubation failure ( = .44). The majority of re-intubation events occurred on the shift opposite of extubation. There was no difference in complications according to shift of re-intubation ( = .72).
Extubation failure was not independently associated with extubation shift in this single-center study. Ventilation liberation should be considered at the first opportunity dictated by clinical data and patient-specific factors rather than by the time of day at centers with similar resources.
大多数儿科患者的拔管操作发生在白天班时间。机械通气时间与并发症之间存在时间依赖性关系。目前尚不清楚拔管时间（白天与夜间）是否与儿科患者的拔管结果相关。如果常规将拔管时间推迟到白天班时间，可能会导致儿科患者的通气时间不必要地延长。
我们假设，拔管失败与拔管时间无关，夜间拔管的首次拔管通气时间和儿科重症监护病房（PICU）的住院时间将更短。这是一项在一家三级护理、24 张床的学术性 PICU 内进行的回顾性队列研究。
共纳入 582 次通气事件，涉及 517 例患者。癫痫持续状态是夜间班拔管的更常见诊断（ =.005），而日间班拔管更常见的是手术气道情况（ =.02）。首次拔管的通气时间（37.6 小时比 62.5 小时， <.001）和 PICU 的住院时间（2.8 天比 4.5 天， <.001）更短。日间班和夜间班的拔管失败率分别为 10.3%和 8.1%（ =.40）。在个体患者水平上进行的逻辑回归模型表明，拔管时间与拔管失败无关（ =.44）。大多数再次插管事件发生在与拔管相反的班次。根据再次插管的班次，并发症没有差异（ =.72）。
在这项单中心研究中，拔管失败与拔管时间无关。在具有相似资源的中心，通气的解除应根据临床数据和患者具体情况决定，而不是根据时间，而应在第一时间考虑。
