dc.contributor.author | Kaguongo, Rachel K | |
dc.date.accessioned | 2019-01-30T08:09:55Z | |
dc.date.available | 2019-01-30T08:09:55Z | |
dc.date.issued | 2018 | |
dc.identifier.uri | http://hdl.handle.net/11295/105990 | |
dc.description.abstract | BACKGROUND
Children, especially those under 5 years of age, are especially at risk of death from
preventable and/or reversible causes particularly in resource-limited settings, which
generally have sparse critical care resources. There is no accepted gold standard on
extubation practice, and only minimal literature from Africa. At the Kenyatta National
Hospital, guidelines based on international literature are utilised, but timing of extubation
continues to rely heavily on clinical judgement. Little is known regarding the prevalence
of extubation failure (EF) in our setting, or the effect of following our current guidelines
on the extubation failure rate.
STUDY OBJECTIVE
This study sought to determine the rate of adherence to extubation guidelines and the
prevalence of extubation failure among paediatric patients extubated at the Kenyatta
National Hospital main and paediatric ICUs. The third objective was to describe the effect
of extubation guideline adherence on extubation failure rate among these mechanically
ventilated paediatric patients at the Kenyatta National Hospital.
METHODS
The study was a hospital based, retrospective, observational cohort study set in the main
ICU and paediatric ICU at Kenyatta National Hospital. The participants were children aged
1 month to 12 years admitted to the ICU/PICU from November 1, 2017 to February 28,
2018 who received mechanical ventilation via endotracheal tube and have an attempted
extubated during their stay in the ICU. An informed consent was obtained for all
participants enrolled in the study. A standard data collection tool was used for data
collection. Data was stored in MS-EXCEL and analysed using STATA 12® software.
RESULTS
The study enrolled 56 out of 84 possible eligible participants aged between 1 month to 12
years, with a total of 62 extubation attempts recorded. Of the participants, 57.2% were
male, and majority of them (89.3%) were below the age of 5 years, with median age of
13.5 months (IQR 2 months – 82 months). Respiratory and neurological diagnoses were a
common reason for intubation in these patients. More than half of the extubations (59.7%)
were carried out in PICU with the rest being in the main ICU. A high incidence of
xiii
unplanned extubations (22.6%) was noted. Only 3 to 8 of the 9 criteria were followed for
each extubation. None of the extubations were carried out in adherence to all 9 criteria of
the guidelines, and most of the extubations (74%) met between 5 to 7 of the guidelines.
The overall extubation failure (EF) rate was 11.3%. EF rate was not significantly different
when comparing planned and unplanned extubations. Use of adrenaline nebulisation,
control of underlying disease and hemodynamic stability evidenced by no inotropic support
in the 24 hours pre-extubation were the 3 parameters shown to be associated with reduced
risk of EF after bivariate analysis. Multivariate analysis however did not show a significant
association.
CONCLUSION
The KNH paediatric extubation guidelines are only partly adhered to in planning for
extubation in the ICUs. Despite this however, our EF rate of 11.3% is comparable to
documented rates worldwide. Of the 9 criteria, 2 (control of underlying disease and
hemodynamic stability) were shown to be protective against EF even in a small population.
The high rate of unplanned extubations and low EF rate in unplanned extubations suggests
that our approach to assessing extubation readiness may be too conservative.
RECOMMENDATIONS
There is need to improve awareness of the healthcare workers in these ICUs on the
extubation guidelines, particularly those that have been shown to have significant effect on
EF. Early weaning and extubation of our paediatric patients may have benefit. Clinical
judgement of a trained and experienced ICU specialist remains vital in determining the best
time to extubate patients, but the guidelines remain useful for less experience healthcare
workers in an ICU setting. Further studies assessing post extubation use of adrenaline
nebulization as an independent variable are indicated in our setting. | en_US |
dc.language.iso | en | en_US |
dc.publisher | University of Nairobi | en_US |
dc.rights | Attribution-NonCommercial-NoDerivs 3.0 United States | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/us/ | * |
dc.subject | Effects of Extubation Guideline Adherence on Extubation Failure Rate Among Mechanically Ventilated Paediatric Patients at the Kenyatta National Hospital. | en_US |
dc.title | Effects of Extubation Guideline Adherence on Extubation Failure Rate Among Mechanically Ventilated Paediatric Patients at the Kenyatta National Hospital. | en_US |
dc.type | Thesis | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |