Seizing the opportunity to extubate locally

Aims Previous audits have demonstrated a significant number of children are extubated shortly following paediatric intensive care unit (PICU) admission, especially those with status epilepticus (CSE).1-3 It may be that a subgroup of patients could be safely extubated at their district general hospital (DGH), avoiding inter-hospital transfer, with potential benefits for patients, families and resource utilisation. Our objectives were to: (1)Determine proportions and characteristics of children referred to a regional paediatric retrieval service (RS) with CSE, including those extubated at their DGH. (2)Compare morbidity associated with extubation in the DGH and PICU settings. (3)Determine compliance with management guidelines. Methods Retrospective audit of children, referred to RS with CSE 1/11/2010-31/8/2011. Clinical and demographic data were obtained from RS logs and PICU records. Patients Excluded: Standards: Regional management guideline for paediatric CSE. Results 73/91 children met inclusion criteria; median age 20 months. 58/73 patients were intubated. 38/58 (65.5%) were extubated ≤24 hrs. 11/58 (19%) were extubated locally with no reported morbidity or reintubations; two extubated by RS (table 1). In eight patients, local extubation was discussed but not undertaken (table 2). One transferred to adult ICU. 46/58 transferred to PICU; 27/46 (58.7%) were extubated ≤24 hours of intubation; only one failed extubation. Pharmacological guidelines not followed for 22/73; eight received >two benzodiazepine doses. Conclusions Our data confirm that a significant number of children with CSE extubate ≤24 hours of intubation and suggest a proportion can be successfully and safely extubated at their DGH. Excessive benzodiazepine use may be a modifiable risk factor for intubation. Prospective studies are merited to further delineate morbidity associated with, and resource implications of local extubation.