Do Clinical Parameters Predict First Planned Extubation Outcome in the Pediatric Intensive Care Unit?

Laham, J; Breheny, Patrick; Rush, Amanda

doi:10.1177/0885066613494338

Cited by 40 publications

(47 citation statements)

References 20 publications

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“…Passing the RESTORE ERT can identify, with good accuracy, children who can be successfully extubated, but the test can say little about those who fail the ERT. Our reported PPV is similar to other pediatric ERTs,(14, 17–19) but these studies may have overestimated their PPV by including children without respiratory disease. The RESTORE ERT slightly improved on the 87% PPV reported by Randolph et al (4)…”

Section: Discussionsupporting

confidence: 81%

“…(13) The association between secretion volume and successful extubation is unclear. (14) Also unclear is whether pulmonary secretions are better removed by endotracheal suctioning or by spontaneous effective coughing without an artificial airway. Objective measures of inadequate secretion management may facilitate future clinical decision-making.…”

Section: Discussionmentioning

confidence: 99%

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Accuracy of an Extubation Readiness Test in Predicting Successful Extubation in Children With Acute Respiratory Failure From Lower Respiratory Tract Disease*

Faustino

Gedeit

Schwarz

et al. 2017

Critical Care Medicine

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OBJECTIVE Identifying children ready for extubation is desirable to minimize morbidity and mortality associated with prolonged mechanical ventilation and extubation failure. We determined the accuracy of an extubation readiness test (RESTORE ERT) in predicting successful extubation in children with acute respiratory failure from lower respiratory tract disease. DESIGN Secondary analysis of data from the RESTORE clinical trial, a pediatric multicenter cluster randomized trial of sedation. SETTING 17 pediatric intensive care units in the intervention arm. PATIENTS Children 2 weeks to 17 years receiving invasive mechanical ventilation for lower respiratory tract disease. INTERVENTION ERT in which spontaneously breathing children with oxygenation index ≤6 were placed on FiO2 of 0.50, positive end expiratory pressure of 5 cm H2O, and pressure support. MEASUREMENTS AND MAIN RESULTS Of 1,042 children, 444 (43%) passed their first ERT. Of these, 295 (66%) were extubated within 10 hours of starting the ERT, including 272 who were successfully extubated, for a positive predictive value of 92%. Among 861 children who were extubated for the first time within 10 hours of performing an ERT, 788 passed their ERT and 736 were successfully extubated for a positive predictive value of 93%. The median time of day for extubation with an ERT was 12:15H compared with 14:54H for extubation without an ERT within 10 hours (p<0.001). CONCLUSIONS In children with acute respiratory failure from lower respiratory tract disease, an ERT, as described, should be considered at least daily if the oxygenation index is ≤6. If the child passes the ERT, there is a high likelihood of successful extubation.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Accuracy of an Extubation Readiness Test in Predicting Successful Extubation in Children With Acute Respiratory Failure From Lower Respiratory Tract Disease*

Faustino

Gedeit

Schwarz

et al. 2017

Critical Care Medicine

View full text Add to dashboard Cite

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“…5,6 El uso de sedantes y analgésicos, el tiempo de asistencia respiratoria mecánica (ARM), la edad de los pacientes, los trastornos de la oxigenación, la inestabilidad hemodinámica, la afección crónica compleja (ACC), la lesión neurológica, los trastornos nutricionales o hidroelectrolíticos y la disfunción diafragmática parecerían aumentar, ya sea en su conjunto o en forma independiente, las posibilidades del FE. [7][8][9] Lic. Julia Simonassi a y Lic.…”

Section: Introductionunclassified

Prevalencia y factores de riesgo del fracaso de extubación en una Unidad de Cuidados Intensivos Pediátricos de alta complejidad

2019

Arch Argent Pediat

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“…5,6 The use of sedatives and analgesics, the length of assisted mechanical ventilation (AMV) use, patients' age, oxygenation disorders, hemodynamic i n s t a b i l i t y , c o m p l e x c h r o n i c conditions (CCCs), neurological injuries, nutritional or electrolyte balance disorders, and diaphragmatic dysfunction appear to increase the possibility of EF, either combined or individually. [7][8][9] A m o n g t h e c a u s e s o f E F , 40 % are attributed to upper airway obstruction (UAO), which is the main reason of failure in the pediatric population. 7 The causes of UAO may be dynamic, such as edema produced by endotracheal tube support and swallowing disorders, or structural, such as malformations, vocal cord paralysis, and granulomas.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of extubation and associated risk factors at a tertiary care pediatric Intensive Care Unit

Simonassi

Sanso

2019

Arch Argent Pediat

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Introduction. Extubation failure (EF) is associated with a higher risk for pneumonia, hospital stay, and mortality. Objective. To determine the prevalence of EF and identify the associated factors in our population. Materials and methods. Observational and retrospective design. All patients aged 1 month old to 18 years old who required mechanical ventilation for more than 12 hours and underwent at least one scheduled extubation during their stay in the 2012-2016 period were included. The aspects related to ventilation and the causes of failure were recorded. Results. Seven hundred and thirty-one patients were extubated and the prevalence of EF was 19.3 %. The causes of failure included upper airway obstruction (51.4 %), muscle fatigue (20.1 %), respiratory center depression (14.6 %), and inability to protect the airways (9.7 %). As per the multivariate analysis, the independent factors that accounted for EF were neurological complex chronic condition (odds ratio [OR] = 2.27; 95 % confidence interval [CI] = 1.21-4.26); acute lower respiratory tract infection in a patient with prior sequelae (OR = 1.87, 95 % CI = 1.11-3.15); acute neurological injury (OR = 1.92, 95 % CI = 1.03-3.57); unplanned extubation (OR = 2.52, 95 % CI = 1.02-6.21), and presence of stridor (OR = 5.84, 95 % CI = 3.66-9.31). Conclusion. The main cause of EF was upper airway obstruction. Neurological sequelae, acute neurological injury, unplanned extubation, and the presence of postextubation stridor were identified as risk factors associated with EF.

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Do Clinical Parameters Predict First Planned Extubation Outcome in the Pediatric Intensive Care Unit?

Cited by 40 publications

References 20 publications

Accuracy of an Extubation Readiness Test in Predicting Successful Extubation in Children With Acute Respiratory Failure From Lower Respiratory Tract Disease*

Accuracy of an Extubation Readiness Test in Predicting Successful Extubation in Children With Acute Respiratory Failure From Lower Respiratory Tract Disease*

Prevalencia y factores de riesgo del fracaso de extubación en una Unidad de Cuidados Intensivos Pediátricos de alta complejidad

Prevalence of extubation and associated risk factors at a tertiary care pediatric Intensive Care Unit

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