Prevalence, Outcomes, and Associated factors of Unplanned Extubation at Pediatric And Neonatal Intensive Care Unit: Multi-Center study
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Date
2024-05
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Addis Ababa University
Abstract
Background: Unplanned extubation have imposed a sizable burden on mortality,
disability and medical cost among pediatrics worldwide. Limited studies have
investigated the prevalence, outcome, and attributable risk factors attributed to
unplanned extubation
Objective: To assess prevalence, outcomes and attributable factors of UPE in pediatric
intensive care unit, Tikur Anbessa specialized hospital, St. Paul, and Minilik II hospitals
in Addis Ababa, Ethiopia 2024
Methodology: The prospective cross sectional was employed to investigate the
incidence, outcomes and attributable risk factors with UPE at Tikur Anbesa, Paul, and
Minilik II hospitals in Addis Ababa, Ethiopia. The normal distribution of continuous
variables was assessed using Shapiro-Wilk test. The mean and standard deviation
calculated for normality distributed data while median and interquartile range
calculated for skewed data. A univariate and multivariate binary logistic regression
analysis was performed to examine the factors associated UPE. The results of logistic
regression reported as adjusted odds rations (OR) with 95% confidence intervals and p-
value < 0.05 are considered statistically significant.
Results: The study included participants with a mean age of 4.6 years (SD=4), with a
slight male predominance of 54.1%. The most common reasons for admission to the
Pediatric ICU were respiratory distress with various causes (23.9%), cardiovascular
conditions (21%), and neurological conditions (11.7%). The overall incidence of UPE in
three hospitals was 37.6%. There were 47 neonates in the study participant from which
14(29.8%) had UPE which is lowered as compared to childhood 39.9%. The study
observed that mortality rate after UPE is higher as compared in childhood (17%versus
7%) and low rate of tolerated after UPE (4.3%versus 10.1%). Upon adjusting for
confounding factors using multivariate binary logistic regression, several variables were
identified as statistically significant predictors of UPE. These included being male
(adjusted odds ratio [AOR] = 2.4, 95% confidence interval [CI] 1.1-5.3, p = 0.032),
having a GCS score of 10T (AOR = 7.1, 95% CI 1.9-26.3, p = 0.003, night shift (AOR =
3.2, 95% CI 1.07-9.5, p = 0.03, Agitate RASS core (AOR = 5.1, 95% CI 1.9-12.9, p =
0.001) and being on CPAP mode of ventilation (AOR = 6.3 95% CI 1.9-20.6 p = 0.002).
Conclusion: The incidence of UPE was significantly high with significant association
with nigh shift, high RASS score, high nurse-to patient ration.
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Keywords
UPE, Pediatric intensive care unit