Risk factors of tracheal extubation failure in children with spinal muscular atrophy combined with pneumonia

Abstract

Objective: To summarize the risk factors of tracheal extubation failure in children with spinal muscular atrophy (SMA) combined with pneumonia. Methods: In this retrospective study, clinical data of 34 children with SMA combined with pneumonia who were hospitalized in Children's Hospital Affiliated to Capital Institute of Pediatrics from August 2018 to December 2021 were analyzed. According to whether the extubation was successful or not, they were divided into the success group and the failure group. The risk factors that may affect the success of extubation between two groups were derived by comparing the clinical characteristics by Mann-Whitney U test and Chi-square test, followed by multivariate Logistic regression. Results: Among the 34 cases, there were 14 males and 20 females, aged 10.8 (6.0,25.2) months at the time of hospitalization, 31 cases were type 1 SMA and 3 cases were type 2. Eleven children were unable to eat independently before intubation, 22 were treated with airway clearance techniques and 28 had multiple pulmonary infections. There were 21 cases in the success group and 13 cases in the failure group. The failure group had higher maximum partial pressure of arterial carbon dioxide level during intubation and higher rate of consolidation changes in chest images before extubation (81 (49,86) vs. 48 (43,56) mmHg (1 mmHg=0.133 kPa), 6/13 vs. 10%(2/21), Z=-2.55, χ2=5.99, both P<0.05). Multivariate Logistic regression analysis showed that tube feeding before intubation (OR =39.88, 95%CI 3.36-473.29, P=0.003) and not receiving airway clearance therapy (OR =14.55, 95%CI 1.35-156.78, P=0.027) were independent risk factors for extubation failure. Conclusions: The independent risk factors of tracheal extubation failure in children with SMA combined with pneumonia are unable to eat independently before intubation and not receiving airway clearance therapy. Therefore, the conditions to improve the success of extubation consist of having the ability to eat independently before intubation, using airway clearance techniques to improve ventilation and to make the chest images as clear as possible.