Spontaneous breathing test in the prediction of extubation failure in the pediatric population

Abstract

Objective To assess whether the spontaneous breathing test can predict the extubation failure in pediatric population.Methods A prospective and observational study that evaluated data of inpatients at the Pediatric Intensive Care Unit between May 2011 and August 2013, receiving mechanical ventilation for at least 24 hours followed by extubation. The patients were classified in two groups: Test Group, with patients extubated after spontaneous breathing test, and Control Group, with patients extubated without spontaneous breathing test.Results A total of 95 children were enrolled in the study, 71 in the Test Group and 24 in the Control Group. A direct comparison was made between the two groups regarding sex, age, mechanical ventilation time, indication to start mechanical ventilation and respiratory parameters before extubation in the Control Group, and before the spontaneous breathing test in the Test Group. There was no difference between the parameters evaluated. According to the analysis of probability of extubation failure between the two groups, the likelihood of extubation failure in the Control Group was 1,412 higher than in the Test Group, nevertheless, this range did not reach significance (p=0.706). This model was considered well-adjusted according to the Hosmer-Lemeshow test (p=0.758).Conclusion The spontaneous breathing test was not able to predict the extubation failure in pediatric population.

Monitoring diaphragm function in a patient with myasthenia gravis: electrical activity of the diaphragm vs. maximal inspiratory pressure

“…The SBT procedure differs with ventilator settings such as PSV, continuous positive airway pressure (CPAP), and T-piece (T-tube). Ferguson et al [ 8 ] and Nascimento et al [ 9 ] reported that the SBT did not predict extubation failure in pediatric patients on PCV because high pressure support with small endotracheal tubes overestimated the readiness for extubation. The most common cause of extubation failure was inadequate gas exchange in the lower respiratory tract problem, which suggested that performing the SBT with pressure support caused respiratory insufficiency.…”

Incidence of Mechanical Ventilation Adverse Events in Critically Ill Children in a Tertiary Pediatric Intensive Care Unit

“…20 , 21 Extubation failure is defined as reintubation or respiratory assistance needed within 48 hours of a scheduled extubation. 22 …”

Non-Invasive Mechanical Ventilation in Children with Previous Unsuccessful Weaning from Respiratory Therapy

“…Weaning from mechanical ventilation (MV) can be defined as the gradual reduction in respiratory support, assigning a spontaneous breathing time to let the child take responsibility for an acceptable gas exchange [3]. The term extubation failure (EF) represents a set of conditions that determine the need for reintubation and MV restoration within the first 24-72h after the removal of the endotracheal tube [3,4].…”

“…Weaning from mechanical ventilation (MV) can be defined as the gradual reduction in respiratory support, assigning a spontaneous breathing time to let the child take responsibility for an acceptable gas exchange [3]. The term extubation failure (EF) represents a set of conditions that determine the need for reintubation and MV restoration within the first 24-72h after the removal of the endotracheal tube [3,4]. Non-invasive mechanical ventilation (NIMV) offers an alternative to intubation with possibility of providing MV in the treatment of acute respiratory failure in infants and children [1] and helps restore diaphragm function as soon as possible in case of good patient-machine synchronization.…”