An evaluation of extubation failure predictors in mechanically ventilated infants and children

Abstract

In a population which had passed SBT, the ability of the traditional weaning indices to discriminate between children successfully extubated and children re-intubated is very poor.

The Use of Extubation Readiness Parameters: A Survey of Pediatric Critical Care Physicians

“…3 Identifying parameters that reliably predict readiness for extubation would improve the quality of care and decrease morbidity and complications related to mechanical ventilation. Studies in adults 10,11 and pediatric patients 12,13 have shown that patients who pass a spontaneous breathing trial (SBT) undergo an extubation readiness trial; 50 -75% are considered ready for extubation. We designed and conducted a survey to determine the frequency of use of extubation readiness parameters such as air leak, rapid shallow breathing index (RSBI), airwayocclusion pressure 0.1 s after the start of inspiratory flow (P 0.1 ), and quantification of secretions and sedation, 3 the methods used, and the attitudes toward these parameters among pediatric critical care physicians.…”

É preciso prever a falha de extubação

“…6 Bousso et al remark that the difference in results could be reflecting the presence of populations with dissimilar characteristics. This is a common situation when analyzing studies conducted in South America, where there is a predominance of primary respiratory diseases 1,5,[8][9][10]14 compared to the United States or Europe, with predominance of elective surgical patients. 4,6,11,15 At this time, there still are no reliable criteria to predict which patients will require reintubation after tolerating a spontaneous breathing trial.…”

Fatores associados ao insucesso no desmame ventilatório de crianças submetidas a cirurgia cardíaca pediátrica

“…In the study of Farias et al [14], the lehgth of stay on IMV was greater in the group that was unsuccessfully weaned. Fontela et al [15] studied children on IMV and reported that 10.5% required re-intubation within 48 hours after extubation; of these children, those that utilized IMV for more than 15 days suffered the highest extubation failure rate.…”

“…The clinical conditions for successful extubation include: adequate respiratory frequency, the absence of the utilization of accessory musculature, the absence of vacillation of the wings of the nose, hemodynamic stability and the absence of convulsive fits [4]. Even so, the selection of the most appropriate time for extubation is one of the most difficult decisions, as there are several publications that identify risk factors of unsuccessful weaning with the criteria varying between the studies; there are no exact protocols in the literature with specific validated data for this group of patients [12][13][14].…”