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

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.