Factors associated with unplanned extubation in children—An analysis of causes

Abstract

In patients with aneurysmal subarachnoid hemorrhage (aSAH), acute cardiac dysfunction and triple-H-therapy, can lead to hypoxemia. Our aim was to assess impact of a protocoled fluid restrictive approach on hypoxemia in these patients.We included prospectively ICU patients with aSAH admitted within 24 h after the bleed. The study was divided into 2 phases. The first phase, from January to December 2012, was designated as control group (group C). The second phase, from February 2014 to January 2015, was designated as study group (group S). Between these periods, a protocoled fluid intake approach was implemented to maintain as low as possible the cumulative fluid balances.Effective fluid restriction was obtained: at day 3 cumulative fluid balances were respectively for group C and group S, 1559 ± 2402 ml and 759 ± 1855 ml (p = 0.04); and 2211 ± 4918 ml vs 529 ± 2806 ml (p = 0.04) at day 7. We observed reduction in proportion of hypoxemic patient in group S compared to group C, at day 3 (22% vs 40%, p = 0.047) and at day 7 (28% vs 57%, p = 0.007).Fluid restrictive management of patients with aSAH decreases number of hypoxemic patients at day 3 and day 7.