Tests and Indices Predicting Extubation Failure in Children: A Systematic Review and Meta-analysis

Abstract

Introduction There is lack of consensus on what constitutes best practice when assessing extubation readiness in children. This systematic review aims to synthesize data from existing literature on pre-extubation assessments and evaluate their diagnostic accuracies in predicting extubation failure (EF) in children. Methods A systematic search in PubMed, EMBASE, Web of Science, CINAHL, and Cochrane was performed from inception of each database to 15 July 2021. Randomized controlled trials or observational studies that studied the association between pre-extubation assessments and extubation outcome in the pediatric intensive care unit population were included. Meta-analysis was performed for studies that report diagnostic tests results of a combination of parameters. Results In total, 41 of 11,663 publications screened were included (total patients, n = 8111). Definition of EF across studies was heterogeneous. Fifty-five unique pre-extubation assessments were identified. Parameters most studied were: respiratory rate (RR) (13/41, n = 1945), partial pressure of arterial carbon dioxide (10/41, n = 1379), tidal volume (13/41, n = 1945), rapid shallow breathing index (RBSI) (9/41, n = 1400), and spontaneous breathing trials (SBT) (13/41, n = 5652). Meta-analysis shows that RSBI, compliance rate oxygenation pressure (CROP) index, and SBT had sensitivities ranging from 0.14 to 0.57. CROP index had the highest sensitivity [0.57, 95% confidence interval (CI) 0.4–0.73] and area under curve (AUC, 0.98). SBT had the highest specificity (0.93, 95% CI 0.92–0.94). Conclusions Pre-extubation assessments studied thus far remain poor predictors of EF. CROP index, having the highest AUC, should be further explored as a predictor of EF. Standardizing the EF definition will allow better comparison of pre-extubation assessments. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-022-00204-w.

Predictors and outcomes of extubation failures in a pediatric intensive care unit: A retrospective study

“…evaluating the pre-extubation assessment and its diagnostic accuracy in predicting EF, 55 unique pre-extubation assessments were found to be poor predictors of EF. 22 …”

Predictive parameters and model for extubation outcome in pediatric patients

“…An earlier study assessed the effects of the parameters of both preextubation patients and ventilators; however, it did not demonstrate any cutoff value or useful clinical implications for bedside care (2). Several parameters have been assessed individually, such as respiratory rate (RR), arterial blood gas, tidal volume (Vt) and maximum inspiratory pressure (3). Other parameters were assessed as collective indexes such as the rapid shallow breathing index (RSBI), pressure index, and CROP index to predict successful extubation (4)(5)(6)(7)(8).…”