Harms Associated with Tracheal Reintubation After Unplanned Extubation: A Retrospective Cohort Study
Bibliographic record
Abstract
Abstract Objective This study evaluates the clinical harm associated with tracheal intubation (TI) after unplanned extubation (UE) in the pediatric intensive care unit (ICU). We hypothesized that TI after UE is associated with a higher risk of adverse airway outcomes (AAOs), including peri-intubation hypoxia. Methods A total of 23,320 TIs from 59 ICUs in patients aged 0 to 17 years from 2014 to 2020 from the National Emergency Airway Registry for Children (NEAR4KIDS) database were evaluated. AAO was defined as any adverse TI-associated event and/or peri-intubation hypoxia (SpO2 < 80%). UE trends were assessed over time. A multivariable logistic regression model was developed to evaluate the association between UE and AAO, while controlling for patient, provider, and practice confounders. Results UE was reported as TI indication in 373 (1.6%) patients, with the proportion increasing over time: 0.1% in 2014 to 2.8% in 2020 (p < 0.001). TIs after UE versus TIs without preceding UE were more common in infants (62 vs. 48%, p < 0.001), males (63 vs. 56%, p = 0.003), and children with a history of difficult airway (17 vs. 13%, p = 0.03). After controlling for potential confounders, TI after UE was not significantly associated with AAO (adjusted odds ratio [aOR]: 1.26, 95% confidence interval [CI]: 0.99–1.62, p = 0.06). However, TI after UE was significantly associated with peri-intubation hypoxia (aOR: 1.35, 95% CI: 1.02–1.79, p = 0.03). Conclusions UE is increasing as an indication for TI, and is more common in infants and children with a history of difficult airway. As TI after UE was associated with increased peri-intubation hypoxia, future study should focus on identifying causality and mitigating peri-intubation risk.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".