Incidence, Outcome and Determinants of Unplanned Extubation Among Pediatric Intensive Care Unit Addis Ababa, Ethiopia, 2023: Nested, Unmatched Case-Control Study Design

Figures & data

Figure 1 Conceptual framework: Determinants of Unplanned extubation (UPEs) among pediatric intensive care unit Addis Ababa, Ethiopia 2023.

Figure 2 Sample size and distribution of patients admitted and intubated in pediatric intensive care unit (PICU), Addis Ababa. Ethiopia 2023.

Table 1 Socio-Demographic Characteristics and Circumstances of Unplanned Extubation Among Children in Pediatric Intensive Care Unit, Addis Ababa, Ethiopia from Sep 2022 to Apr 2023

Variables	All (N 198)	Controls (n 132)	UPE Cases (n 66)
Gender
Male	116 (58.58%)	74 (56.06%)	42 (63.63%)
Female	82 (41.41%)	58 (43.94%)	24 (36.36%)
Age
< 6 months	69 (34.8%)	43 (32.6%)	26 (39.39%)
6–12 months	44 (22.2%)	29 (21.97%)	15 (22.72%)
13–72 months	61 (30.8%)	44 (33.33%)	17 (25.8%)
>72 months	24 (12.1%)	16 (12.12%)	8 (12.12%)
Ad. Dx
Sepsis	64 (32.32%)	41 (31.06%)	23 (34.84%)
Respiratory	97 (48.98%)	64 (48.48%)	33 (50.0%)
Cardiovascular	14 (7.1%)	11 (8.33%)	3 (4.5%)
Neurologic	20 (10.1%)	14 (10.6%)	6 (9.2%)
Trauma	3 (1.5%)	2 (1.5%)	1 (1.5%)
ETT location;
Corner of mouth	195(%)	132(100%)	63(95.45%)
Center of mouth	3(%)	0(0.0%)	3(4.54%)
Mood:
SIMV	150(75.7%)	97(73.5%)	53(80.3%)
PRVC	25(12.6%)	20(15%)	5(7.6%)
CPAP	13(6.6%)	8(6%)	5(7.6%)
AC	10(5%)	7(5.3%)	3(4.5%)
Phase;
Acute/stable vent. Setting	52(26.26%)	–	52(78.8%)
Weaning vent. Setting	14(7.07%)	–	14(21.2%)
Weaning completed	132(66.67%)	132(100%)	–
Severity;
Re-intubation within 1hr	20(10%)	5(3.8%)	15(22.72%)
Re-intubation +CPR + drug	20(10%)	–	20(30.3%)
Re-intubation after 1 hr.	11(5.56%)	8(6.06%)	3(4.55%)
Difficulty of re-intubation	8(4.04%)	–	8(12.12%)
No need of re-intubation	139(70.2%)	119(90.2%)	20(30.3%)
LOS. MV
<5 days	102 (51.5%)	68(51.5%)	34 (51.5%)
5–9	61 (30.8%)	43 (32.6%)	18 (27.3%)
10–14	24 (12.12%)	15 (11.36%)	9 (13.6%)
15–19	7 (3.5%)	3 (2.3%)	4 (6.06%)
≥20	4 (2.02%)	3 (2.3%)	1(1.5%)
LOS PICU
<7 days	98 (49.5%)	67 (50.8%)	31(47.0%)
7–14	79(39.9%)	54(40.9%)	25(37.9%)
14–21	11 (5.56%)	6 (4.5%)	5(7.6%)
≥ 21	10 (5.05%)	5 (3.8%)	5(7.6%)

Abbreviations: MV, Mechanical ventilation; PE, Planned extubation; PICU, Pediatrics intensive care unit; TT, Tracheostomy tube; UPE, Unplanned extubation; SIMV, spontaneous intermittent mandatory mechanical ventilation; PRVC, pressure-regulated volume control ventilation; LOS, length of stay.

Figure 3 Producers Aactivities at a time of unplanned extubation at the selected public hospital in Addis Ababa City, Ethiopia, 2022.

Table 2 Determinants of Unplanned Extubation Among Children in Pediatrics Intensive Care Unit in Addis Ababa, Ethiopia, 2023

Variable	Controls=132	Cases=66	COR (99% CI)	AOR (99% CI)	P-value
Agitation;
Yes	43 (32.6%)	45 (68.2%)	4.286 (1.868–9.833)	3.708(1.401–9.81)	0.001***
No	89 (67.4%)	21(31.8%)
Shift
Day	123 (93%)	45 (68.2%)	6.378 (2.081–19.548)	8.789 (2.37–32.58)	0.000***
Night	9 (7%)	21 (31.2%)
Taping;
Both	119 (90%)	46 (69.7%)	3.980 (1.434–11.046)	4.12(1.215–13.96)	0.003**
RB/Plaster	13 (10%)	20 (30.3%)
Staffing
1: 1	131(99.3%)	43(65.2%)	4.172 (1.581–11.011)	6.65 (1.87–23.698)	0.000*
1: 2	1(0.75%)	23(34.9%)
Sedation;
Continues	50 (37.9%)	17 (25.8%)	1.758 (0.–4.153)	3.96 (1.127–13.91)	0.005*
Intermittent	82 (62.1%)	49 (78.2%)
Physical. restraint
Yes	20 (15%)	21(31.8%)	2.613 (1.037–6.586)	3.717 (1.02–13.54)	0.009*
No	112(84.9%)	45 (68.2%)
Discharge;
Recovered	126 (95.5%)	41(62.1%)	12.805(3.635–45.108)	14.855 (3. 24–68.097)	000***
Deceased	6(4.5%)	25(37.9%)

Notes: Both= plaster + roll bandage, RB= roll bandage, P = physical, endotracheal tube (ETT) = endotracheal tube, ***P = < 0.000, **P= < 0.001, *P= ≤ 0.01.

Table 3 Outcomes of the Patients Experienced UPE Compared to the Unmatched Control Participants 2023

Variable	Total N = 198	Control n = 132	Case n= 66
Reintubation	59 (29.8%)	13 (9.85%)	46 (69.7%)
● Only reintubation	41 (20.71%)	11(8.33%)	30(45.45%)
● Tracheostomy	6 (3.03%)	2(1.5%)	4(6.06%)
● Pneumothorax	2(1.01%)	0	2(3.03%)
● Mortality	7(3.53%)	0	7(10.6%)
● Rib fracture	3(1.5%)	0	3(4.54%)
Well tolerated	139 (70.2%)	119(90%)	20(30%)
Outcome
○ Recovered	167(84.35%)	126 (95.5%)	41(62.1%)
○ Deceased	31(15.65%)	6(4.5%)	25(37.9%)

Figure 4 The immediate outcomes of after unplanned and planned extubation among Pediatrics Intensive Care Unit in Addis Ababa, Ethiopia, 2023.

Figure 5 Recovery and death of the patients experiencing unplanned extubation compared to the unmatched control participants 2023.