Detection and validation of predictors of successful extubation in critically ill children

Toida, Chiaki; Muguruma, Takashi; Miyamoto, Masashi

doi:10.1371/journal.pone.0189787

Cited by 13 publications

(22 citation statements)

References 13 publications

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“…OSI) may lead to a volutrauma in which ultra-structural lung injury is occurring because of using high pressure support. Our study supports close follow-up of ventilatory settings to avoid complications and decrease the extubation failure rate (19).…”

Section: Discussionsupporting

confidence: 81%

Predictors of Failed Extubation in Mechanically Ventilated Children: Single Center Experience

Ishak

Mohamed²,

El-Sherbini³

et al. 2022

Pediatric Sciences Journal

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Background: Extubation failure is failure to maintain normal spontaneous breathing after a period of mechanical ventilation with the need for reintubation within 24-72 hours. It has multiple risk factors such as deconditioned muscles, upper airway edema and others. Aim of the Work:To study the frequency and causes of extubation failure in mechanically ventilated children. Patients and Methods: This is an observational prospective study that included all admitted children in Pediatric Intensive Care Unit (PICU), Cairo University Children Hospital who underwent mechanical ventilation (MV) through endotracheal tube for more than 48 hours (145 child) with Glasgow coma scale above 8. They were subdivided into successfully extubated (78 children) and failed extubation (67 children). Results:The mean ± SD age of the cohort was 13.5 ± 15.15 months (range1.3-48, median= 8 months). Of them 80 (55.17%) were males, and 65 (44.8%) were females. The commonest underlying diagnosis was pneumonia in 38 (26.2%), bronchial asthma in 32 (22%), encephalopathy in 32 (22%), and aspiration in 11 (7.58%). Failed extubation was encountered in 67 (46.2%) children. The encountered risk factors of extubation failure were: sedation in 12 (16.7%) (p=0.001), excessive tracheal secretion of more than 200 ml /24 h in 14 (18.7%) (p=0.03), accidental extubation in 27 (40.3%) (p=0.01) and the need for higher setting on MV in all 67 children with failed extubation. Among failed extubated patients, the mean± SD for peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (FiO2) were 14.5± 1.8 /cm H2O, 5.5± 0.5/cm H2O, and 27.5± 6.1% respectively. While, PIP, PEEP, and FiO2 in the successfully extubated group were 12.8± 1.6 /cm H2O, 4.1± 0.4/cm H2O, and 24.8± 5.3%, (p= 0.01, p=0.001 and p= 0.001) respectively. Patients who underwent gradual withdrawal of ventilatory support had a higher frequency of successful extubation than those extubated accidentally (p= 0.01). Sensitivity, and specificity of above mentioned indices for successful extubation were 53.79%, and 28.72% respectively. Conclusion: Causes of extubation failure are the need for long duration of sedation, excessive tracheal secretion, and need for high setting on MV. Furthermore, gradual weaning decreases the frequency of extubation failure. There is a need for a more sensitive and specific comprehensive objective indicator(s) for successful timely extubation.

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Section: Discussionsupporting

confidence: 81%

Predictors of Failed Extubation in Mechanically Ventilated Children: Single Center Experience

Ishak

Mohamed²,

El-Sherbini³

et al. 2022

Pediatric Sciences Journal

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“…Previous studies evaluating whether newborns should be extubated have focused on clinical symptoms and pulmonary function indicators. 23 , 24 The present study indicates that pH and age at extubation may be used as significant predictors of failed extubation and suggests cut-off values to judge extubation failure.…”

Section: Discussionmentioning

confidence: 67%

Predictors of extubation outcomes among extremely and very preterm infants: a retrospective cohort study

He¹,

Wu²,

Sun³

et al. 2022

Jornal de Pediatria

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“…Numerous other studies have focused on extubation in children in the neonatal or pediatric intensive care unit. [8][9][10] In all of these studies though, failure is most often a result of ongoing cardiopulmonary embarrassment and not simply a miscalculation of anesthetic depth at extubation. As a consequence, any insights garnered from them are likely to be of limited value in the setting of routine extubation in the operating room.…”

Section: Perioperative Medicinementioning

confidence: 99%

Assessment of Common Criteria for Awake Extubation in Infants and Young Children

et al. 2019

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Practice patterns surrounding awake extubation of pediatric surgical patients remain largely undocumented. This study assessed the value of commonly used predictors of fitness for extubation to determine which were most salient in predicting successful extubation following emergence from general anesthesia with a volatile anesthetic in young children. Methods This prospective, observational study was performed in 600 children from 0 to 7 yr of age. The presence or absence of nine commonly used extubation criteria in children were recorded at the time of extubation including: facial grimace, eye opening, low end-tidal anesthetic concentration, spontaneous tidal volume greater than 5 ml/kg, conjugate gaze, purposeful movement, movement other than coughing, laryngeal stimulation test, and oxygen saturation. Extubations were graded as Successful, Intervention Required, or Major Intervention Required using a standard set of criteria. The Intervention Required and Major Intervention Required outcomes were combined as a single outcome for analysis of predictors of success. Results Successful extubation occurred in 92.7% (556 of 600) of cases. Facial grimace odds ratio, 1.93 (95% CI, 1.03 to 3.60; P = 0.039), purposeful movement odds ratio, 2.42 (95% CI, 1.14 to 5.12; P = 0.022), conjugate gaze odds ratio, 2.10 (95% CI, 1.14 to 4.01; P = 0.031), eye opening odds ratio, 4.44 (95% CI, 1.06 to 18.64; P= 0.042), and tidal volume greater than 5 ml/kg odds ratio, 2.66 (95% CI, 1.21 to 5.86; P = 0.015) were univariately associated with the Successful group. A stepwise increase in any one, in any order, of these five predictors being present, from one out of five and up to five out of five yielded an increasing positive predictive value for successful extubation of 88.3% (95% CI, 82.4 to 94.3), 88.4% (95% CI, 83.5 to 93.3), 96.3% (95% CI, 93.4 to 99.2), 97.4% (95% CI, 94.4 to 100), and 100% (95% CI, 90 to 100). Conclusions Conjugate gaze, facial grimace, eye opening, purposeful movement, and tidal volume greater than 5 ml/kg were each individually associated with extubation success in pediatric surgical patients after volatile anesthetic. Further, the use of a multifactorial approach using these predictors, may lead to a more rational and robust approach to successful awake extubation.

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Detection and validation of predictors of successful extubation in critically ill children

Cited by 13 publications

References 13 publications

Predictors of Failed Extubation in Mechanically Ventilated Children: Single Center Experience

Predictors of Failed Extubation in Mechanically Ventilated Children: Single Center Experience

Predictors of extubation outcomes among extremely and very preterm infants: a retrospective cohort study

Assessment of Common Criteria for Awake Extubation in Infants and Young Children

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