Study on the risk factors of post-extubation dysphagia in children with endotracheal intubation in PICU and constructon of prediction model

Objective: To investigate the risk factors of post-extubation dysphagia (PED) in children with endotracheal intubation in the pediatric intensive care unit(PICU) and to construct a risk prediction model,so as to provide a reference for early identification and prevention of post-extubation dysphagia in children with endotracheal intubation in PICU. Methods: A total of 84 children with mechanical ventilation admitted to the PICU of Anhui Provincial Children's Hospital from October 2020 to October 2023 were retrospectively selected as the research subjects.According to the presence or absence of PED,the children were divided into the dysphagia group and non-dysphagia group.Logistic regression was used to analyze the risk factors of dysphagia in children in PICU after extubation.The selected risk factors were used to construct a prediction model according to the regression coefficient,and the Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were used to test and evaluate the goodness of fit and prediction effects of the model. Results: There were 40 patients in the dysphagia group and 44 patients in the non-dysphagia group,and the incidence of dysphagia was 47.62%.The results of binary logistic regression analysis showed that age ≤3 years,nervous system damage,midazolam(pumped),indwelling time of endotracheal intubation ≥72 h,indwelling time of gastric tube ≥72 h and iatrogenic withdrawal syndrome were the independent risk factors of PED after extubation in children with endotracheal intubation in PICU.The ROC curve results showed that the AUC was 0.791,95%CI:0.688-0.894,which indicated that the model had good prediction efficiency.Hosmer-Lemeshow test showed P=0.10,which indicated that the model had a good goodness of fit. Conclusions: The age,midazolam,neurological impairment,indwelling time of endotracheal intubation,indwelling time of gastric tube,and iatrogenic withdrawal syndrome are the risk factors of PED in children with endotracheal intubation.The risk prediction model based on the above factors can visually evaluate the risk of PED in children with endotracheal intubation in PICU,and has certain clinical application value.