Risk factors for extubation failure in mechanically ventilated pediatric patients

Fontela, Patr??cia S.; Piva, Jefferson Pedro; García, Pedro Celiny Ramos; Bered, Patr??cia L.; Zilles, K??tia

doi:10.1097/00130478-200503000-00026

Cited by 27 publications

(57 citation statements)

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“…Pediatric studies relating to weaning and extubation fall into two broad categories – those that describe practice (usually within a single PICU)7;22;57;58 and those which seek to identify predictors of successful extubation, usually retrospectively4;18;31–34;59–61. Less commonly, prospective studies19 have been done where patients are randomized and extubated after reaching a predetermined physiological goal.…”

Section: Concepts Of Weaning Spontaneous Breathing and Extubation Rementioning

confidence: 99%

Weaning and extubation readiness in pediatric patients*

Newth

Venkataraman

Willson

et al. 2009

Pediatric Critical Care Medicine

265

194

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Objective-A systematic review of weaning and extubation for pediatric patients on mechanical ventilation. Data Selection-Pediatric and Adult Literature, English languageStudy Selection-Invited review Data Sources-Literature review using National Library of Medicine PubMed from January 1972 until April 2008, earlier cross-referenced article citations, the Cochrane Database of Systematic Reviews and the Internet.Conclusions-Despite the importance of minimizing time on mechanical ventilation, only limited guidance on weaning and extubation is available from the pediatric literature. A significant proportion of patients being evaluated for weaning are actually ready for extubation, suggesting that weaning is often not considered early enough in the course of ventilation. Indications for extubation are even less clear, although a trial of spontaneous breathing would seem a prerequisite. Several indices have been developed in an attempt to predict weaning and extubation success but the available literature would suggest they offer no improvement over clinical judgment. Extubation failure rates range from 2-20% and bear little relationship to the duration of mechanical ventilation. Upper airway obstruction is the single most common cause of extubation failure. A reliable method of assessing readiness for weaning and predicting extubation success is not evident from the pediatric literature.

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Section: Concepts Of Weaning Spontaneous Breathing and Extubation Rementioning

confidence: 99%

Weaning and extubation readiness in pediatric patients*

Newth

Venkataraman

Willson

et al. 2009

Pediatric Critical Care Medicine

265

194

View full text Add to dashboard Cite

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“…Otherwise, the length of ventilation and the number of extubation failures are clearly identified as independent risk factors for VAP in pediatric patients [42]. As the prolongation of ventilation and extubation failure rates are associated with a deep sedation [43,44], the reduction of sedation administration may be an effective target to reduce VAP.…”

Section: Non-medicinal Meansmentioning

confidence: 99%

Healthcare-associated infection prevention in pediatric intensive care units: a review

Joram

Blanquat

Stamm

et al. 2012

Eur J Clin Microbiol Infect Dis

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The objective of this review was to summarize the current knowledge base on the prevention of nosocomial infections in pediatric intensive care units (PICUs). Healthcare-associated infections (HAIs) are a crucial problem in PICUs because of their impact on patient outcome, length of hospital stay, and costs. Studies published between 1998 and 2011 were identified using the MEDLINE and Cochrane databases. Randomized, cohort, case-control studies, and meta-analyses concerning global strategies of prevention, general organization of the wards, general recommendations on antibiotic management, and measures for the prevention of ventilator-associated pneumonia (VAP), bloodstream infections (BSIs), urinary tract infections (UTIs), and surgical site infections (SSIs) were incorporated. Limits of age from 1 month to 18 years were used. When recommendations could not be supported by the pediatric literature, adult studies were also reviewed. This review excludes the neonate population. Specific pediatric data are often lacking so as to establish specific evidence-based pediatric recommendations. This review underlines the absolute necessity of pediatric studies and to harmonize the definitions of HAIs.

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“…There are a number of factors that may contribute to extubation failure in pediatric patients. Fontela et al [61] recently found that younger age and duration of mechanical ventilation were two variables associated with an increased risk for extubation failure. In this study, the authors also suggest that prolonged treatment with sedatives and analgesics during mechanical ventilation contributes significantly to the extubation failure rate [61].…”

Section: Weaning Mechanical Ventilatory Support and Extubationmentioning

confidence: 99%

“…Fontela et al [61] recently found that younger age and duration of mechanical ventilation were two variables associated with an increased risk for extubation failure. In this study, the authors also suggest that prolonged treatment with sedatives and analgesics during mechanical ventilation contributes significantly to the extubation failure rate [61]. In a recent multicenter PALISI trial [62 ], overall fluid balance was not found to affect ventilator weaning and extubation.…”

Section: Weaning Mechanical Ventilatory Support and Extubationmentioning

confidence: 99%

See 1 more Smart Citation

Insights in pediatric ventilation: timing of intubation, ventilatory strategies, and weaning

Turner

Arnold

2007

Current Opinion in Critical Care

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Mechanical ventilation with pressure limitation and low tidal volumes has become customary in pediatric intensive care units, and this lung protective approach will continue into the foreseeable future. Further investigation is warranted regarding use of high frequency oscillatory ventilation, airway pressure release ventilation, and surfactant to assist pediatric intensivists in application of these therapies.

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Risk factors for extubation failure in mechanically ventilated pediatric patients

Cited by 27 publications

References 0 publications

Weaning and extubation readiness in pediatric patients*

Weaning and extubation readiness in pediatric patients*

Healthcare-associated infection prevention in pediatric intensive care units: a review

Insights in pediatric ventilation: timing of intubation, ventilatory strategies, and weaning

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