Gillett Ethan L, Jayadeep Sneha, Akmyradov Chary, Aljabari Salim
Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Science, Little Rock, AR 72205, USA.
Arkansas Children's Hospital, Little Rock, AR 72205, USA.
Children (Basel). 2025 Apr 30;12(5):586. doi: 10.3390/children12050586.
: Critically ill patients with acute neurological injury commonly require intubation. The true incidence of and risk for extubation failure in pediatric patients with an acute neurologic injury is not well reported, making the assessment of these patients for extubation readiness or the need for tracheostomy challenging. This study aims to better delineate the incidence of extubation failure and factors associated with the need for tracheostomy in pediatric patients surviving an acute neurologic injury. : We conducted a retrospective cohort study using the Virtual Pediatric System (VPS) database of neonates, infants, children, and adolescents < 18 years of age with a neurological injury requiring intubation from 2012 to 2022. Demographic and clinical variables were compared between subjects that were successfully extubated, those with early tracheostomy placement (≤14 days), and those with late tracheostomy placement (>14 days). : Of the 38,810 enrolled subjects, 37,661 (97.04%) were successfully extubated, 481 (1.24%) underwent early tracheostomy, and 668 (1.72%) underwent late tracheostomy. The most common etiologies were seizures (60.6%), trauma (20.9%), and intoxication (9.1%). The successfully extubated subjects had a higher median initial GCS score (8 vs. 5 and 4, < 0.001) and fewer extubation attempts (1 vs. 3 and 3, < 0.001) than the tracheostomy cohorts. There was a significant difference in median ICU days between the three groups (2.52 vs. 18.3 vs. 38.3, < 0.001). : The majority of pediatric patients requiring intubation following an acute neurological injury can be successfully extubated. Among patients requiring a tracheostomy, those who received it early had significantly shorter ICU and hospital stays.
急性神经损伤的重症患者通常需要插管。小儿急性神经损伤患者拔管失败的真实发生率和风险尚未得到充分报道，这使得评估这些患者是否准备好拔管或是否需要气管切开术具有挑战性。本研究旨在更好地描述急性神经损伤存活小儿患者拔管失败的发生率以及与气管切开术需求相关的因素。
我们使用虚拟儿科系统（VPS）数据库进行了一项回顾性队列研究，该数据库涵盖了2012年至2022年期间18岁以下因神经损伤需要插管的新生儿、婴儿、儿童和青少年。比较了成功拔管的受试者、早期气管切开术（≤14天）的受试者和晚期气管切开术（>14天）的受试者之间的人口统计学和临床变量。
在38,810名登记受试者中，37,661名（97.04%）成功拔管，481名（1.24%）接受了早期气管切开术，668名（1.72%）接受了晚期气管切开术。最常见的病因是癫痫发作（60.6%）、创伤（20.9%）和中毒（9.1%）。与气管切开术队列相比，成功拔管的受试者初始GCS评分中位数更高（8分对5分和4分，<0.001），拔管尝试次数更少（1次对3次和3次，<0.001）。三组之间的ICU住院天数中位数存在显著差异（2.52天对18.3天对38.3天，<0.001）。
大多数急性神经损伤后需要插管的小儿患者可以成功拔管。在需要气管切开术的患者中，早期接受气管切开术的患者ICU和住院时间明显更短。
