Extubation failure in pediatric intensive care: A multiple-center study of risk factors and outcomes

Kurachek, Stephen C.; Newth, Christopher J. L.; Quasney, Michael W.; Rice, Tom; Sachdeva, Ramesh; Patel, Neal; Takano, Jeanne; Easterling, Larry; Scanlon, Matthew C.; Musa, Ndidiamaka; Brilli, Richard J.; Wells, Dan; Park, Gary S; Penfil, Scott; Bysani, Kris; Nares, Michael; Lowrie, Lia; Billow, Michael; Chiochetti, Emilie; Lindgren, Bruce R.

doi:10.1097/01.ccm.0000094228.90557.85

Cited by 247 publications

(295 citation statements)

References 45 publications

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“…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. Future investigations should focus on the search for factors that will allow us to determine the appropriate time for the withdrawal of sedation before weaning and extubation and to prevent respiratory infection after extubation.…”

mentioning

confidence: 99%

É preciso prever a falha de extubação

Farias¹,

Monteverde²

2006

J. Pediatr. (Rio J.)

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mentioning

confidence: 99%

É preciso prever a falha de extubação

Farias¹,

Monteverde²

2006

J. Pediatr. (Rio J.)

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“…Premature extubation can cause respiratory muscle fatigue, gas exchange failure, and loss of airway protection [100]. It can also increase morbidity, mortality, ICU stay, mechanical ventilation duration, as well as the risk of nosocomial infection, sedative dependency, and airway trauma due to re-intubation [103][104][105][106].…”

Section: Predicting Extubation Failurementioning

confidence: 99%

“…Premature extubation usually leads to extubation failure, which refers to the need to re-intubate and restore mechanical ventilation within a certain time period, such as 48 hours, after extubation [104][105][106][107][108]. Extubation failure happens to 15-20% of child patients [104,[106][107][108], 22-28% of premature neonatal patients [104], and 17-19% of adult patients [104] in the ICU.…”

Section: Predicting Extubation Failurementioning

confidence: 99%

“…Such predictive models should use multiple indices obtained from diverse instruments and modalities, because an index obtained from a single device can be easily affected by systematic error that cannot be reduced through increasing the sample size [100]. Although various predictors of extubation failure have been proposed in the research literature [100,[104][105][106][107][108][109], there is currently no consensus on which predictors should be used [100,107].…”

Section: Predicting Extubation Failurementioning

confidence: 99%

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A systematic review of predictive modeling for bronchiolitis

Luo

Nkoy

Gesteland

et al. 2014

International Journal of Medical Informatics

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Purpose: Bronchiolitis is the most common cause of illness leading to hospitalization in young children. At present, many bronchiolitis management decisions are made subjectively, leading to significant practice variation among hospitals and physicians caring for children with bronchiolitis. To standardize care for bronchiolitis, researchers have proposed various models to predict the disease course to help determine a proper management plan. This paper reviews the existing state of the art of predictive modeling for bronchiolitis. Predictive modeling for respiratory syncytial virus (RSV) infection is covered whenever appropriate, as RSV accounts for about 70% of bronchiolitis cases.Methods: A systematic review was conducted through a PubMed search up to April 25, 2014. The literature on predictive modeling for bronchiolitis was retrieved using a comprehensive search query, which was developed through an iterative process.Search results were limited to human subjects, the English language, and children (birth-18 years). Results:The literature search returned 2,312 references in total. After manual review, 168 of these references were determined to be relevant and are discussed in this paper. We identify several limitations and open problems in predictive modeling for bronchiolitis, and provide some preliminary thoughts on how to address them, with the hope to stimulate future research in this domain. Conclusions:Many problems remain open in predictive modeling for bronchiolitis. Future studies will need to address them to achieve optimal predictive models.

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“…[9][10][11] Current literature cites wide-ranging incidences of upper airway obstruction in the non-cardiac pediatric ICU population from 5-40%. [12][13][14] Despite the fact that it is also a well-recognized postoperative sequela in children undergoing cardiac surgery, data on characteristics of patients at risk for extrathoracic upper airway obstruction and the frequency with which it occurs within this patient population are limited. We therefore aimed to determine the incidence of extrathoracic upper airway obstruction after pediatric cardiac surgery at our institution and identify risk factors for its occurrence.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors for Upper Airway Obstruction after Pediatric Cardiac Surgery

Green

Walters

Delius

et al. 2015

The Journal of Pediatrics

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Objective: To determine the incidence of and risk factors for extrathoracic upper airway obstruction after pediatric cardiac surgery.Study Design: A retrospective chart review was performed on 213 patients less than 18 years of age who recovered from cardiac surgery in our multidisciplinary intensive care unit in 2012.Clinically significant upper airway obstruction was defined before performing the chart review as post-extubation stridor with at least one of the following: greater than two corticosteroid doses, receiving helium-oxygen therapy, or re-intubation. Multivariate logistic regression analysis was performed to determine independent risk factors for this complication.Results: Thirty-five patients (16%) with extrathoracic upper airway obstruction were identified.On bivariate analysis, patients with upper airway obstruction had greater surgical complexity, higher vasoactive medication requirements, and longer postoperative durations of endotracheal intubation. They were also more difficult to calm while on mechanical ventilation, as indicated by higher narcotic infusion doses and greater likelihood to receive dexmedetomidine or vecuronium. On multivariable analysis, adjunctive use of dexmedetomedine or vecuronium (odds ratio: 4.4, 95% confidence intervals: 1.8-10.5) remained independently associated with upper airway obstruction. Conclusion:Extrathoracic upper airway obstruction is relatively common following pediatric cardiac surgery, especially in children who are difficult to calm while endotracheally intubated.Postoperative upper airway obstruction could represent an important outcome measure in future studies of optimal sedation practices in this patient population.2

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Extubation failure in pediatric intensive care: A multiple-center study of risk factors and outcomes

Abstract: A variety of patient features are associated with an increase in extubation failure rate, and serious outcome consequences characterize the extubation failure population in PICUs.

Cited by 247 publications

References 45 publications

É preciso prever a falha de extubação

É preciso prever a falha de extubação

A systematic review of predictive modeling for bronchiolitis

Prevalence and Risk Factors for Upper Airway Obstruction after Pediatric Cardiac Surgery

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