Prediction of extubation failure in newborns, infants and children: brief report of a prospective (blinded) cohort study at a tertiary care paediatric centre in India

Abstract

BackgroundExtubation failure (EF), defined as need for re-intubation within 24–72 h, is multifactorial. Factors predicting EF in adults generally are not useful in children.ObjectiveTo determine the factors associated with EF and to facilitate prediction of EF in mechanically ventilated infants and children less than 12 years of age.Material and MethodsDesign Prospective cohort study. Setting PICU and NICU of a multispecialty tertiary care institute. Patients All consecutive newborns, infants and children, who remained on the ventilator for more than 12 h, were included. Patients with upper airway obstruction, neuromuscular disorders, complex anatomic malformations, accidental extubation, tracheostomy or death before extubation were excluded. Methods The pre-extubation clinical, laboratory and ventilatory parameters were collected for 92 cases over a one and half year period. The EF rate was calculated for each variable using STATA 9. All the treating physicians were blinded to the data collection procedure.Measurements and ResultsDemographics were comparable between the extubation success and EF groups. Respiratory failure was the main cause requiring ventilation (46.74 %, 95 % CI 0.37–0.57) as well as EF (30.23 %, 95 % CI 0.08–0.23). 76.92 % (95 % CI 0.58–0.89) of patients that failed extubation had alterations in respiratory effort, 38.46 % (95 % CI 0.22–0.57) each had either poor or increased respiratory effort. Poor cough reflex (p = 0.001), thick endotracheal secretions (p = 0.02), failed spontaneous breathing trial (SBT) (p = 0.001) and higher rapid shallow breathing index (RSBI) (p = 0.001) were found to be associated with EF.ConclusionsPaediatric EF is multifactorial. Increased or poor respiratory effort and failed SBT are potential factors in deciding re-intubation. Increased RSBI, poor cough reflex and thick.

Rapid Shallow Breathing Index as a Predictor of Extubation Outcomes in Pediatric Patients Underwent Cardiac Surgeries at King Faisal Cardiac Center

“…This similar study revealed no association between the RSBI measurements and extubation outcomes [ 20 ]. In other studies about pediatric patients in general, they found an association between the measurements of RSBI prior to extubation and the extubation outcomes which is a prediction of extubation success with low RSBI similar to the results in the two hours prior to extubation RSBI measurements in our study [ 9 , 10 , 22 , 23 ]. Unlike our study, some of these studies established a threshold, cut-off point, to predict the successful extubation, but these cut-off points were variable and ranging from 6.7 to 11 [ 9 , 10 , 23 ].…”

Protocol Driven Extubation in Neonates- A Quality Improvement Initiative

“…We read with interest the study on a quality improvement (QI) initiative for extubation in newborns [1]. Failed extubation is a common problem faced by healthcare workers across all neonatal intensive care units [2,3] and a QI initiative designed to improve this is a welcome step. We have two observations regarding this reasonably wellconducted study.…”

Predictive parameters and model for extubation outcome in pediatric patients

“…However, these parameters were predominantly used in research and not in a clinical setting ( 9 ). Moreover, some of these parameters have proven helpful in adults but are not generally used in children ( 10 ). The occlusion pressure (P0.1) is the decrease in airway pressure 100 ms after occluded inspiration ( 11 ).…”