Do in-hours or off-hours matter for extubating children in the pediatric intensive care unit?

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• 作者：Paulo Sé ; rgio Lucas da Silva ; MD ; MSc^a ; ^{psls.nat@terra.com.br" class="auth_mail" title="E-mail the corresponding author} ; Maria Eunice Reis ; MD^b ; ^{eunice.resi@terra.com.br" class="auth_mail" title="E-mail the corresponding author} ; Thais Suelotto Machado Fonseca^c ; ^{thais.smfonseca@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Marcelo Cunio Machado Fonseca ; MD ; PhD^d ; ^{marcelo.fonseca@axia.bio.br" class="auth_mail" title="E-mail the corresponding author}
• 关键词：CI ; Confidence interval ; COMFORT b ; COMFORT behavior scale ; FLACC ; Face ; Legs ; Activity ; Cry ; Consolability scale ; HR ; hazard ratio ; IQR ; interquartile ranges ; MV ; mechanical ventilation ; PICU ; pediatric intensive care unit ; PRISM ; Pediatric Risk of Mortality score ; PELOD ; Pediatric Logistic Organ Dysfunction score ; VAP ; ventilator-associated pneumonia
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：36
• 期：Complete
• 页码：97-101
• 全文大小：335 K

文摘

Several studies have suggested worse outcomes for patients requiring medical care at night or on weekends. However, whether or not children should be extubated only during in-hours has not been studied yet. We sought to compare outcomes and complications of in-hours versus off-hours extubated patients.

Methods

We prospectively included all children receiving invasive mechanical ventilation (MV) in a pediatric intensive care unit. Off-hours extubations included patients who were extubated at nighttime (8:00 class="smallcaps">pm-7:59 class="smallcaps">am) plus weekends/holidays whereas the in-hours extubations included regular daytime weekdays (Monday to Friday: 8:00 class="smallcaps">am-7:59 class="smallcaps">pm).

Results

Of the 480 patients, 346 (72%) were extubated during in-hours period and 134 (28%) were extubated during off-hours. In-hours patients spent a longer time to have planned extubation and had a longer MV duration and pediatric intensive care unit stay compared to those extubated at off-hours. Kaplan–Meier curve showed that in-hours patients were more likely to have a longer time until the first extubation (log-rank test: P = .006, HR: 5.05).

Conclusion

Patients extubated at off-hours had more favorable outcomes with similar complications rate compared with those extubated at in-hours. These results provide no support for delaying extubations until in-hours period. Further studies are required to confirm these findings.