Early extubations in children intubated prior to arrival in Paediatric Burn ICU, a single center retrospective study over 1520 admissions.

Abstract

Background: In adult burns intensive care units, more than 30% of patients arriving intubated, are extubated within 2 days (potentially unnecessary intubation, PUNI). Such data are lacking in paediatric populations. Exploring this paediatric PUNI rate was the primary aim of the study.

Methods: Data from all the admissions to our paediatric burn intensive care unit were retrospectively analyzed over an 8-years period. Extubations within the first two days among patients arriving intubated were assessed as the primary outcome (PUNI rate). Using a univariate logistic regression and a multivariate model, we analyzed factors associated with intubation lasting more than 2 days (potentially necessary intubation, PNI). Finally, we developed a score to predict the probability of PNI.

Results: Among the 1520 admitted children (age: 0-17; Percentage of Total Body Surface Area (%TBSA): 1- 97%), 56 (4%) arrived intubated, 20 (36%) of whom were considered PUNI. These patients had smaller %TBSA burned compared to those having PNI (24 ± 17% vs 48 ± 24%, p = 0.002). We developed a score based on factors independently associated with PNI: %TBSA burned (OR = 1.12 [1.09-1.15] for each additional per cent), flame burns (OR = 4.43 [1.64-11.6]) and facial burns (OR = 12.28 [3.41-67.4]). Seven children (<0.5%) were intubated after admission.

Conclusion: Intubation before admission to a burn intensive care unit was less frequent in children. The paediatric rate of PUNI, however, was close to findings reported in adults: approximately one-third of intubated children were extubated within 2 days.