Publications by authors named "Michael Billow"

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Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes.

Crit Care Med 2003 Nov;31(11):2657-64

University of Minnesota Department of Pediatrics and Childrens Hospitals and Clinics, Minneapolis, USA.

Objective: To determine a contemporary failed extubation rate, risk factors, and consequences of extubation failure in pediatric intensive care units (PICUs). Three hypotheses were investigated: a) Extubation failure is in part disease specific; b) preexisting respiratory conditions predispose to extubation failure; and c) admission acuity scoring does not affect extubation failure.

Design: Twelve-month prospective, observational, clinical study.

Setting: Sixteen diverse PICUs in the United States.

Patients: Patients were 2,794 patients from the newborn period to 18 yrs of age experiencing a planned extubation trial.

Interventions: None.

Measurements And Main Results: A descriptive statistical analysis was performed, and outcome differences of the failed extubation population were determined. The extubation failure rate was 6.2% (174 of 2,794; 95% confidence interval, 5.3-7.1). Patient features associated with extubation failure (p <.05) included age < or =24 months; dysgenetic condition; syndromic condition; chronic respiratory disorder; chronic neurologic condition; medical or surgical airway condition; chronic noninvasive positive pressure ventilation; the need to replace the endotracheal tube on admission to the PICU; and the use of racemic epinephrine, steroids, helium-oxygen therapy (heliox), or noninvasive positive pressure ventilation within 24 hrs of extubation. Patients failing extubation had longer pre-extubation intubation time (failed, 148.7 hrs, SD +/- 207.8 vs. success, 107.9 hrs, SD +/- 171.3; p <.001), longer PICU length of stay (17.5 days, SD +/- 15.6 vs. 7.6 days, SD +/- 11.1; p <.001), and a higher mortality rate than patients not failing extubation (4.0% vs. 0.8%; p <.001). Failure was found to be in part disease specific, and preexisting respiratory conditions were found to predispose to failure whereas admission acuity did not.

Conclusion: A variety of patient features are associated with an increase in extubation failure rate, and serious outcome consequences characterize the extubation failure population in PICUs.
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http://dx.doi.org/10.1097/01.CCM.0000094228.90557.85DOI Listing
November 2003