Paediatric anaesthesia & critical care
Contemporary Trends in Pediatric Extubation Failure and Noninvasive Respiratory Support Use
Main finding · Postextubation noninvasive respiratory support useResult — go to the resultRelative risk 1.90 95% CI 1.83–1.98Authors' conclusion
Our results demonstrate that in the last decade, noninvasive respiratory support after extubation has nearly doubled, with an approximately 10% reintubation risk reduction.
Study context
- Population
- Patients younger than 19 years receiving invasive mechanical ventilation (IMV) for ≥ 24 hours and extubated 2013–2022, 158 North American sites (Virtual Pediatric Intensive Care database)
- Participants
- 132,712 unique encounters
- Exposure
- 2013 vs 2022
- Outcome
- Changes in EF risk factors, EF rates, postextubation noninvasive respiratory support practices and patient-centered outcomes
Methodological detailsmulticentre, quality improvement database
- Multicentre
- Quality improvement database
Main finding
As reported in the abstract
Postextubation noninvasive respiratory support use
Relative risk
1.90
95% CI 1.83–1.98
P < 0.01
By group
2022 vs 2013
RR 1.90 (95% CI 1.83–1.98); P < 0.01
- Overall extubation failure (EF) rate
- 8.5%
Observational data: associations, not effects.
Further findings
| Outcome | 2013 | 2022 | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| EF ≤ 48 hours | 8.9% | 8.1% | 0.92 (0.85–0.99) | P = 0.03 | |
| EF ≤ 7 days | 12.3% | 11.0% | 0.89 (0.83–0.95) | P < 0.01 | |
| Outcomes with EF vs without EFEF vs No EF · all-cause risk-adjusted mortality 8.5% vs 8.6% | 1.16 (0.97–1.38) | P = 0.73 | |||
| 0.512Relative risk (log scale) |
Risk factors for EF (logistic regression)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Age < 6 weeks | 1.39 (1.31–1.47) | P < 0.01 | |
| Age 6 weeks-12 months | 1.24 (1.18–1.30) | P < 0.01 | |
| Primary renal diagnosis | 1.25 (1.04–1.48) | P = 0.01 | |
| Respiratory diagnosis | 1.15 (1.07–1.23) | P < 0.01 | |
| Cardiac diagnosis | 1.10 (1.04–1.16) | P < 0.01 | |
| ≥ 7 days invasive ventilation before extubation | 1.26 (1.21–1.32) | P < 0.01 | |
| 0.512Odds ratio (log scale) |
| Outcome | Estimate | P value |
|---|---|---|
| Outcomes with EF vs without EFEF vs No EF | mechanical ventilation duration 11.6 days vs 4.0 days days | P < 0.01 |
| Outcomes with EF vs without EFEF vs No EF | PICU LOS 18.8 days vs 7.9 days days | P < 0.01 |
| Outcomes with EF vs without EFEF vs No EF | hospital LOS 31.0 days vs 15.0 days days | P < 0.01 |
Risk factors for EF (logistic regression)
- EF rates unchanged over time for patients with 0 or 1 risk factor
Original publication
Contemporary Trends in Pediatric Extubation Failure and Noninvasive Respiratory Support Use. Chest. Published 14 August 2025. doi:10.
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