Seizing the opportunity to extubate locally?

Abstract

<h3>Aims</h3> Previous audits have demonstrated a significant number of children are extubated shortly following paediatric intensive care unit (PICU) admission, especially those with status epilepticus (CSE).1-3 It may be that a subgroup of patients could be safely extubated at their district general hospital (DGH), avoiding inter-hospital transfer, with potential benefits for patients, families and resource utilisation. Our objectives were to: (1)Determine proportions and characteristics of children referred to a regional paediatric retrieval service (RS) with CSE, including those extubated at their DGH. (2)Compare morbidity associated with extubation in the DGH and PICU settings. (3)Determine compliance with management guidelines. <h3>Methods</h3> Retrospective audit of children, referred to RS with CSE 1/11/2010-31/8/2011. Clinical and demographic data were obtained from RS logs and PICU records. Patients Excluded: &lt;1 month or &lt;37/40; those with tracheostomies; intracranial tumours; trauma or neurosurgical emergencies. Standards: Regional management guideline for paediatric CSE. <h3>Results</h3> 73/91 children met inclusion criteria; median age 20 months. 58/73 patients were intubated. 38/58 (65.5%) were extubated ≤24 hrs. 11/58 (19%) were extubated locally with no reported morbidity or reintubations; two extubated by RS (table 1). In eight patients, local extubation was discussed but not undertaken (table 2). One transferred to adult ICU. 46/58 transferred to PICU; 27/46 (58.7%) were extubated ≤24 hours of intubation; only one failed extubation. Pharmacological guidelines not followed for 22/73; eight received &gt;two benzodiazepine doses. <h3>Conclusions</h3> Our data confirm that a significant number of children with CSE extubate ≤24 hours of intubation and suggest a proportion can be successfully and safely extubated at their DGH. Excessive benzodiazepine use may be a modifiable risk factor for intubation. Prospective studies are merited to further delineate morbidity associated with, and resource implications of local extubation.