Extubation failure in pediatric intensive care incidence and outcomes

Baisch, Steven D.; Wheeler, William Bruce; Kurachek, Stephen C.; Cornfield, David N.

doi:10.1097/01.pcc.0000161119.05076.91

Cited by 152 publications

(166 citation statements)

References 47 publications

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“…In our study, extubation failure occurred in nearly one-fifth of neonates, which is consistent with the range of 10-27% reported in other studies of children recovering from pediatric cardiac surgery [10][11][12][13][14][15]. The definition of extubation failure has varied in prior studies examining extubation failure in children with cardiac disease [10][11][12][13][14][15], with some defining extubation failure as the need for re-intubation within 24-48 hours while others have used 96 hours as their definition. Authors who have employed the latter definition [13][14][15] have asserted that extubation failure in patients with underlying cardiac disease can be slow to evolve and thus the time frame for extubation failure should be expanded beyond 48 hours.…”

Section: Discussionsupporting

confidence: 74%

“…Extubation failure is often tumultuous in these patients, and can be associated with considerable postoperative morbidity and prolonged length of stay in the intensive care unit, especially in neonates [10]. To date, existing literature that has reported risk factors for extubation failure specific to patients recovering from pediatric cardiac surgery have been either large heterogeneous groups of children that ranged widely in age [11][12] or smaller studies focused on specific lesions [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Extubation Failure Following Neonatal Cardiac Surgery*

Laudato

Gupta

Walters

et al. 2015

Pediatric Critical Care Medicine

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Objective: Extubation failure after neonatal cardiac surgery has been associated with considerable postoperative morbidity, though data identifying risk factors for its occurrence are sparse. We aimed to determine risk factors for extubation failure in our neonatal cardiac surgical population. Design: Retrospective chart reviewSetting: Urban tertiary care free-standing children's hospital Interventions: Extubation failure was defined as re-intubation within 72 hours after extubation from mechanical ventilation. Multivariate logistic regression analysis was performed to determine independent risk factors for extubation failure. Measurements & Main Conclusions:Neonates with underlying genetic abnormalities, hypoplastic left heart, or postoperative infection were at increased risk for extubation failure. A more conservative approach in these patients, including longer pre-extubation duration of antibiotic therapy for postoperative infections, may be warranted.3

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Extubation Failure Following Neonatal Cardiac Surgery*

Laudato

Gupta

Walters

et al. 2015

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

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“…Following reintubation, these neonates are then committed to another course of mechanical ventilation, with its inherent risks and exposures such as ventilator-associated infections, airway trauma, and the need for sedative infusions. In neonates and children undergoing cardiac surgery, extubation failure has been consistently associated with increased postoperative morbidity and mortality [3][4][5][6][7]. Prevention of this important complication is therefore an essential part of optimizing clinical outcomes in this patient population.…”

Section: Introductionmentioning

confidence: 99%

Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis

Mastropietro

Cashen

Grimaldi

et al. 2017

The Journal of Pediatrics

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Objectives: To describe the epidemiology of extubation failure and identify risk factors for its occurrence in a multicenter population of neonates undergoing surgery for congenital heart disease. Study Design:We conducted a prospective observational study of neonates ≤ 30 days of age who underwent cardiac surgery at seven centers within the United States in 2015. Extubation failure was defined as reintubation within 72 hours of the first planned extubation. Risk factors were identified using multivariable logistic regression analysis and reported as odds ratios (OR) with 95% confidence intervals (CI). Multivariable logistic regression analysis was also conducted to examine the relationship between extubation failure and worse clinical outcome, defined as hospital length-of-stay in the upper 25% or operative mortality.

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“…Premature extubation leading to cardiorespiratory compromise necessitates reintubation and reinstitution of mechanical ventilation and increases mortality and morbidity (1), whereas prolonged ventilatory support exposes the child to increased risk of nosocomial infection and lung injury (2). Extubation failure has been reported to occur in 4 to 10% of children (3,4), hence an accurate predictor of extubation outcome would be of significant clinical value (1).…”

mentioning

confidence: 99%

Tension–Time Index as a Predictor of Extubation Outcome in Ventilated Children

Harikumar¹,

Egberongbe²,

Nadel³

et al. 2009

Am J Respir Crit Care Med

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Rationale: Indices that assess the load on the respiratory muscles, such as the tension-time index (TTI), may predict extubation outcome. Objectives: To evaluate the performance of a noninvasive assessment of TTI, the respiratory muscle tension time index (TTmus), by comparison to that of the diaphragm tension time index (TTdi) and other predictors of extubation outcome in ventilated children. Methods: Eighty children (median [range] age 2.1 yr [0.15-16]) admitted to pediatric intensive care units at King's College and St Mary's Hospitals who required mechanical ventilation for more than 24 hours were studied. Measurements and Main Results: TTmus, maximal inspiratory pressure, respiratory drive, respiratory system mechanics, and functional residual capacity using a helium dilution technique, the rapid shallow breathing and CROP indices (compliance, rate, oxygenation, and pressure) indexed for body weight were measured and standard clinical data recorded in all patients. TTdi was measured in 28 of the 80 children using balloon catheters. Eight children (three in the TTdi group) failed extubation. TTmus (0.199 vs. 0.09) and TTdi (0.157 vs. 0.07) were significantly higher in children who failed extubation. TTmus greater than 0.18 (n 5 80) and TTdi greater than 0.15 (n 5 28) had sensitivities and specificities of 100% in predicting extubation failure. The other predictors performed less well. Conclusions: Invasive and noninvasive measurements of TTI may provide accurate prediction of extubation outcome in mechanically ventilated children.Keywords: diaphragm; respiratory muscles; pediatric critical care; weaningPatients are extubated when assessed to be capable of sustaining spontaneous ventilation without respiratory support. Premature extubation leading to cardiorespiratory compromise necessitates reintubation and reinstitution of mechanical ventilation and increases mortality and morbidity (1), whereas prolonged ventilatory support exposes the child to increased risk of nosocomial infection and lung injury (2). Extubation failure has been reported to occur in 4 to 10% of children (3, 4), hence an accurate predictor of extubation outcome would be of significant clinical value (1).Univariate indices that examine a single aspect of physiological function often have poor predictive power probably because they do not fully reflect all the pathophysiological processes affecting extubation outcome (5). Accurate prediction is more likely using multivariate indices that integrate a number of physiological functions (6). Studies of multivariate indices in children, such as the rapid-shallow breathing index (RSB) (respiratory rate [RR] divided by tidal volume [VT]) (5) and the CROP index (compliance, RR, oxygenation, and inspiratory pressure [PI]), however, have been limited and yielded contradictory results. We (7) and others (8, 9) have shown that the predictive power of those indices in children is poor, whereas Baumeister and colleagues (10), demonstrated that the CROP index discriminated strongly between successful an...

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Extubation failure in pediatric intensive care incidence and outcomes

Cited by 152 publications

References 47 publications

Risk Factors for Extubation Failure Following Neonatal Cardiac Surgery*

Risk Factors for Extubation Failure Following Neonatal Cardiac Surgery*

Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis

Tension–Time Index as a Predictor of Extubation Outcome in Ventilated Children

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