[Value of sTREM-1 in serum and bronchoalveolar lavage fluid, APACHE II score, and SOFA score in evaluating the conditions and prognosis of children with severe pneumonia]

Establishment and Validation of the Risk Nomogram of Poor Prognosis in Patients with Severe Pulmonary Infection Complicated with Respiratory Failure

Objective

To investigate the prognosis of patients with severe pulmonary infection combined with respiratory failure and analyze the influencing factors of prognosis.

Methods

The clinical data of 218 patients with severe pneumonia complicated with respiratory failure were retrospectively analyzed. The risk factors were analyzed by univariate and multivariate logistic regression analyses. The risk nomogram and Bootstrap self-sampling method were used for internal inspection. Calibration curves and receiver operating characteristic (ROC) curve were drawn to assess the predictive ability of the model.

Results

Among 218 patients, 118 (54.13%) cases had a good prognosis and 100 (45.87%) cases had a poor prognosis. Multivariate logistic regression analysis showed that the number of complicated basic diseases ≥5, APACHE II score >20, MODS score >10, PSI score >90, and multi-drug resistant bacterial infection were independent risk factors affecting the prognosis (P<0.05), and the level of Alb was an independent protective factor (P<0.05). The consistency index (C-index) was 0.775, and the Hosmer Lemeshow goodness-of-fit test showed that the model was not significant (P>0.05). The area under the curve (AUC) was 0.813 (95% CI: 0.778~0.895), with the sensitivity of 83.20%, and the specificity of 77.00%.

Conclusion

The risk nomograph model had good discrimination and accuracy in predicting the prognosis of patients with severe pulmonary infection combined with respiratory failure, which may provide a basis for early identification and intervention of patients at clinical risk and improve the prognosis.

Predictive factors of extubation failure in pediatric cardiac intensive care unit: A single-center retrospective study from Thailand

Introduction/objective

Extubation failure increases morbidity and mortality in pediatric cardiac patients, a unique population including those with congenital heart disease or acquired heart disease. This study aimed to evaluate the predictive factors of extubation failure in pediatric cardiac patients and to determine the association between extubation failure and clinical outcomes.

Methods

We conducted a retrospective study in the pediatric cardiac intensive care unit (PCICU) of the Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, from July 2016 to June 2021. Extubation failure was defined as the re-insertion of the endotracheal tube within 48 hours after extubation. Multivariable log-binomial regression with generalized estimating equations (GEE) was performed to explore the predictive factors associated with extubation failure.

Results

We collected 318 extubation events from 246 patients. Of these, 35 (11%) events were extubation failures. In physiologic cyanosis, the extubation failure group had significantly higher SpO₂ than the extubation success group (P < 0.001). The predictive factors associated with extubation failure included a history of pneumonia before extubation (RR 3.09, 95% CI 1.54-6.23, P = 0.002), stridor after extubation (RR 2.57, 95% CI 1.44-4.56, P = 0.001), history of re-intubation (RR 2.24, 95% CI 1.21-4.12, P = 0.009), and palliative surgery (RR 1.87, 95% CI 1.02-3.43, P = 0.043).

Conclusion

Extubation failure was identified in 11% of extubation attempts in pediatric cardiac patients. The extubation failure was associated with a longer duration of PCICU stay but not with mortality. Patients with a history of pneumonia before extubation, history of re-intubation, post-operative palliative surgery, and post-extubation stridor should receive careful consideration before extubation and close monitoring afterward. Additionally, patients with physiologic cyanosis may require balanced circulation via regulated SpO₂.