Extubation in the pediatric intensive care unit: predictive methods. An integrative literature review

Moura, Jéssica Cristina da Silva; Gianfrancesco, Lívea; Souza, Tiago Henrique de; Hortêncio, Taís Daiene Russo; Nogueira, Roberto José Negrão

doi:10.5935/0103-507x.20210039

Cited by 6 publications

(4 citation statements)

References 36 publications

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“…Studies have often quoted HCO 3 levels less than 18 mmol/L to be associated with extubation failure [7]. Similarly, low HCO 3 levels have been related to an increase in the reintubation rate [8]. It is also an independent factor in predicting extubation outcomes [9].…”

Section: Discussionmentioning

confidence: 99%

Does Arterial Blood Gas (ABG) Provide a Safety Net for Extubation in Surgical Patients?

Hazarika¹,

Singla²,

Patel³

et al. 2023

Cureus

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BackgroundExtubation has always been a critical aspect of anaesthesia. Guidelines and recommendations are in place for achieving successful extubation, but the risk of failure always persists. Through this study, we assess whether arterial blood gas (ABG) values taken intraoperatively help predict extubation success in the operation theatre. Materials and methodsThis was a prospective observational study for one year of extubated patients whose blood gas values were not within the normal range. The patients of age 18 years and above undergoing high-risk elective and emergency surgeries where at least one intraoperative arterial blood sample was taken for blood gas analysis were included. Apart from parameters of ABG demographic data, urgency and duration of surgery, blood loss, urine output, use of intraoperative fluid(s), and blood product(s) were also observed. ResultsOf 578 patients enrolled, 116 patients were extubated based on the predefined extubation criteria. Of these, 24 patients were reintubated within 24 hours. ABG parameters such as partial pressure of arterial oxygen (PaO 2 ) and serum HCO 3-levels were significantly lower in the reintubated patients compared to nonreintubated patients (p-values of 0.045 and 0.003, respectively). ConclusionThis study showed that the PaO 2 <100 mm Hg or ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) of less than 200 and an HCO 3-value of less than 18 are plausible ABG parameters to decide extubation in post-surgery patients in OT. PaCO 2 , base deficit, and lactate were less reliable parameters for planning extubation.

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Section: Discussionmentioning

confidence: 99%

Does Arterial Blood Gas (ABG) Provide a Safety Net for Extubation in Surgical Patients?

Hazarika¹,

Singla²,

Patel³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…In a recent study, investigators identified 8 predictive measures for determining extubation readiness in children. 8 Notably, none of those identified was EIT measurements. However, of those 8, the most commonly used methods are the spontaneous breathing test, the rapid shallow breathing index, and the maximum inspiratory pressure.…”

Section: See the Original Study On Page 383mentioning

confidence: 99%

Electrical Impedance Tomography in Mechanically Ventilated Children: Will It Impact Clinical Care?

2022

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“…Several parameters have been assessed individually, such as respiratory rate (RR), arterial blood gas, tidal volume (Vt) and maximum inspiratory pressure (3). Other parameters were assessed as collective indexes such as the rapid shallow breathing index (RSBI), pressure index, and CROP index to predict successful extubation (4)(5)(6)(7)(8). However, these parameters were predominantly used in research and not in a clinical setting (9).…”

Section: Introductionmentioning

confidence: 99%

Predictive parameters and model for extubation outcome in pediatric patients

et al. 2023

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BackgroundProlonged mechanical ventilation is associated with significant morbidity in critically ill pediatric patients. In addition, extubation failure and deteriorating respiratory status after extubation contribute to increased morbidity. Well-prepared weaning procedures and accurate identification of at-risk patients using multimodal ventilator parameters are warranted to improve patient outcomes. This study aimed to identify and assess the diagnostic accuracy of single parameters and to develop a model that can help predict extubation outcomes.Materials and methodsThis prospective observational study was conducted at a university hospital between January 2021 and April 2022. Patients aged 1 month to 15 years who were intubated for more than 12 h and deemed clinically ready for extubation were enrolled. A weaning process with a spontaneous breathing trial (SBT), with or without minimal setting, was employed. The ventilator and patient parameters during the weaning period at 0, 30, and 120 min and right before extubation were recorded and analyzed.ResultsA total of 188 eligible patients were extubated during the study. Of them, 45 (23.9%) patients required respiratory support escalation within 48 h. Of 45, 13 (6.9%) were reintubated. The predictors of respiratory support escalation consisted of a nonminimal-setting SBT [odds ratio (OR) 2.2 (1.1, 4.6), P = 0.03], >3 ventilator days [OR 2.4 (1.2, 4.9), P = 0.02], occlusion pressure (P0.1) at 30 min ≥0.9 cmH2O [OR 2.3 (1.1, 4.9), P = 0.03], and exhaled tidal volume per kg at 120 min ≤8 ml/kg [OR 2.2 (1.1, 4.6), P = 0.03]; all of these predictors had an area under the curve (AUC) of 0.72. A predictive scoring system to determine the probability of respiratory support escalation was developed using a nomogram.ConclusionThe proposed predictive model, which integrated both patient and ventilator parameters, showed a modest performance level (AUC 0.72); however, it could facilitate the process of patient care.

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Extubation in the pediatric intensive care unit: predictive methods. An integrative literature review

Cited by 6 publications

References 36 publications

Does Arterial Blood Gas (ABG) Provide a Safety Net for Extubation in Surgical Patients?

Does Arterial Blood Gas (ABG) Provide a Safety Net for Extubation in Surgical Patients?

Electrical Impedance Tomography in Mechanically Ventilated Children: Will It Impact Clinical Care?

Predictive parameters and model for extubation outcome in pediatric patients

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