{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T23:33:55Z","timestamp":1788478435808,"version":"build-2803163510"},"reference-count":24,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T00:00:00Z","timestamp":1675728000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Pediatric extubation failure is associated with morbidity and mortality. The most common cause is upper-airway obstruction. Subglottic edema is common, but upper-airway obstruction can occur from the oral cavity to the trachea. Dichotomous categorization of extubation failure as airway versus non-airway may help identify risk factors as well as strategies that translate to lower extubation failure rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This was as single-center, retrospective cohort study of invasive mechanical ventilation encounters within a quality improvement database between October 1, 2017\u2013November 30, 2020. Utilizing a 3-physician adjudication process, all extubation failures were categorized as airway versus non-airway. Primary outcome was failure subtype prevalence. Secondary outcome was failure subtype risk factors. Clinical outcomes were explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The all-cause extubation failure rate was 10% in a cohort of 844 encounters. Airway and non-airway extubation failure represented 60.7% and 39.3%, respectively. Most airway failures were due to upper-airway obstruction (84.3%)\u201435.3% were supraglottic, 25.5% subglottic, and 23.5% mixed. Other causes of airway failure were airway patency\/secretions (11.8%) and aspiration (3.9%). Non-airway failures were attributed to respiratory failure (75.8%), encephalopathy (15.2%), and other (9%). All-cause extubation failure was associated with dysgenetic\/syndromic comorbidity (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .005), \u2265 3 concurrent comorbid conditions (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .007), indication for invasive ventilation (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), and longer invasive mechanical ventilation duration (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Airway extubation failure was significantly associated with the presence of a respiratory comorbidity (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01) and Glasgow coma scale &lt; 10 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02). No significant non-airway failure risk factors were identified. Longer pediatric ICU (PICU) stay (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and PICU mortality (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) were associated with all-cause extubation failure. No significant outcome associations with extubation failure subtype were identified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Airway extubation failure prevalence was 1.5 times higher than non-airway failure. Potential risk factors for airway failure were identified. These findings are hypothesis generating for future study focused on key evidence gaps and pragmatic bedside application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.10341","type":"journal-article","created":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T11:15:54Z","timestamp":1675768554000},"page":"374-383","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Prevalence, Risk Factors, and Outcomes of Airway Versus Non-Airway Pediatric Extubation Failure"],"prefix":"10.1177","volume":"68","author":[{"given":"Jeremy M","family":"Loberger","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananya","family":"Manchikalapati","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Borasino","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Cardiology, Section of Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Prabhakaran","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,2,7]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-0207"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002956"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199202000-00008"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199002000-00007"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000094228.90557.85"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001340101035"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001285"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.20.2561"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002024"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05477"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002326"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e318193724d"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3181849901"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2006.01.007"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-018-2150-6"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.158.2.9711045"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.5935\/0103-507X.20180046"},{"issue":"6","key":"e_1_3_2_19_2","first-page":"e0710","article-title":"Ventilation liberation practices among 380 international pediatric intensive care units","volume":"4","author":"Loberger J","year":"2022","unstructured":"Loberger J, , Campbell C, , Colleti J, , Borasino S, , Abu-Sultaneh S, , Khemani R. Ventilation liberation practices among 380 international pediatric intensive care units. Crit Care Explor, 2022; 4(6):e0710.","journal-title":"Crit Care Explor"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001143"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002724"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201506-1064OC"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2012.11.009"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2018.08.008"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05926"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.4187\/respcare.10341","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.10341","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.10341","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T08:58:20Z","timestamp":1775465900000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4187\/respcare.10341"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,7]]},"references-count":24,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.4187\/respcare.10341"],"URL":"https:\/\/doi.org\/10.4187\/respcare.10341","relation":{},"ISSN":["0020-1324"],"issn-type":[{"value":"0020-1324","type":"print"}],"subject":[],"published":{"date-parts":[[2023,2,7]]}}}