Tracheal extubation in children: Planning, technique, and complications

Veyckemans, Francis

doi:10.1111/pan.13774

Cited by 27 publications

(21 citation statements)

References 36 publications

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“…In situations where the clinician has decided to remove the endotracheal tube deep, it is essential to make sure the airway has been cleared of excess blood and/or secretions prior to extubation and that the patient does not cough or respond with an interruption of regular respirations following pharyngeal or laryngeal stimulation 63 . Typically, this will occur at greater than one mean alveolar concentration (MAC) of inhalational agent, although some would suggest aiming for an even higher MAC level 50,64 . Following extubation, the patient should be monitored closely for upper airway obstruction and maintenance of spontaneous ventilation and re‐accumulation of secretions.…”

Section: Main Articlementioning

confidence: 99%

“…The anesthesiologist must also decide on their comfort in potentially managing a significant perioperative respiratory adverse event were it to occur in the setting of a native airway for deep extubation, or with an endotracheal tube in place in the setting of an awake extubation. 64…”

Section: Deep Compared To Awake Extubationmentioning

confidence: 99%

“…Some clinicians may want to keep the patient's airway secure with an endotracheal tube in place to minimize laryngospasm or aspiration risks, acknowledging that the patient may be at increased risk of hypoxemia and bronchospasm, secondary to the mechanical stimulation by the endotracheal tube. The anesthesiologist must also decide on their comfort in potentially managing a significant perioperative respiratory adverse event were it to occur in the setting of a native airway for deep extubation, or with an endotracheal tube in place in the setting of an awake extubation 64 …”

Section: Main Articlementioning

confidence: 99%

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Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia—Part 2: Anesthesia‐related risk and treatment options

Templeton

Sommerfield

Hii

et al. 2021

Pediatric Anesthesia

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Perioperative respiratory adverse events are the most common cause of critical events in children undergoing anesthesia and surgery. While many risk factors remain unmodifiable, there are numerous anesthetic management decisions which can impact the incidence and impact of these events, especially in at-risk children. Ongoing research continues to improve our understanding of both the influence of risk factors and the effect of specific interventions. This review discusses anesthesia risk factors and outlines strategies to reduce the rate and impact of perioperative respiratory adverse events with a chronologic based inquiry into anesthetic management decisions through the perioperative period from premedication to postoperative disposition.

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Section: Main Articlementioning

confidence: 99%

Section: Deep Compared To Awake Extubationmentioning

confidence: 99%

Section: Main Articlementioning

confidence: 99%

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Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia—Part 2: Anesthesia‐related risk and treatment options

Templeton

Sommerfield

Hii

et al. 2021

Pediatric Anesthesia

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“…These experts in pediatric mechanical ventilation nowadays recommend the following: avoidance of a high tidal volume, monitoring expired tidal volume and end-tidal CO 2 (EtCO 2 ) and using a low inspired fraction of oxygen (FiO 2 ), a positive end-expiratory pressure (PEEP), and recruitment maneuvers, but also avoidance of unnecessary tracheal suction in order to prevent atelectasis formation (see Appendix B). [5][6][7][8][9][10][11] In the absence of a high level of evidence for optimal ventilation criteria in anesthetized children with healthy lungs, the aim of the present study was to assess current ventilatory management practice during pediatric anesthesia in France, looking specifically at the parameters defined in the above-mentioned expert statements and with a specific focus on tidal volume.…”

Section: Introductionmentioning

confidence: 99%

Ventilation in pediatric anesthesia: A French multicenter prospective observational study (PEDIAVENT)

Lebossé

Kern

Queiroz

et al. 2020

Pediatric Anesthesia

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Introduction Protective ventilation is now a standard of care in adults. However, management of ventilation is heterogeneous in children and little is known regarding the mechanical ventilation parameters actually used during pediatric anesthesia. Aim The aim of the study was to assess current ventilatory practices during pediatric anesthesia in France and to compare them with pediatric experts' statements, with a specific focus on tidal volume. Patients and methods We conducted a prospective multicenter observational study, regarding the ventilatory management and the mechanical ventilation parameters, over two days (21 and 22 June 2017) in 29 pediatric centers in France. All children undergoing general anesthesia during these 2 days were eligible; those who required extracorporeal circulation or one‐lung ventilation were excluded. Results A total of 701 children were included; median [IQR] age was 60 [24‐120] months. Among the patients in whom controlled ventilation was used, 254/515 (49.3%) had an expired tidal volume >8 mL/kg and 44 children (8.8%) an expired tidal volume ≥10 mL/kg. Lower weight and use of a supraglottic airway device were significantly associated with provision of a tidal volume ≥10 mL/kg (odds ratio 0.94, 95% confidence interval [0.92; 0.97], P < .001 and 2.28 [1.20; 4.31], P = .012, respectively). The positive end‐expiratory pressure was set at a median [IQR] of 4 [3‐5] cmH2O; it was <3 cmH2O in 15.7% of children and not used in 56/499 (9.3%). Among intubated children, 57 (18.3%) received a tidal volume < 10 mL/kg with a positive end‐expiratory pressure ≥3 cmH2O in association with recruitment maneuvers. Conclusions Ventilatory practices in children were heterogenous, and a large proportion of children were not ventilated as it is currently recommended by some experts.

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“…However, related studies are mainly focused on awake patients, and the use of peak cough flow rate meter is prone to the risk of cross-infection. In this study, the method of measuring the change of IAP was used to evaluate the cough intensity to predict the outcome of extubation [37][38][39]. It is not only suitable for conscious patients, but also for patients who are unconscious and uncooperative with coughing.…”

Section: Discussionmentioning

confidence: 99%

Intra-abdominal pressure for predicating extubation failure in mechanically ventilated patients: it does work

et al. 2021

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IntroductionReducing the extubation failure is vital to the early recovery of patients with mechanical ventilation(MV). We aimed to explore the predictive value of the change of intra-abdominal pressure(ΔIAP) before extubation on the extubation failure in MV patients.Material and methodsPatients undergone MV for more than 24 hours were selected. We used a urodynamic monitor to measure ΔIAP 30 minutes before extubation. The characteristics and prognosis of MV patients were analyzed. Receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of ΔIAP for extubation failure.ResultsA total of 173 MV patients were included. The risks of extubation failure increased with the decrease of ΔIAP. The risk of extubation failure in ΔIAP≤21mmHg group was 5.7 times that of the ΔIAP≥38mmHg group (OR 5.7, 95%CI 1.5-22.0), the risk of extubation failure in ΔIAP 22～37 mmHg group was 3.8 times that of the ΔIAP≥38mmHg group (OR 3.8, 95%CI 1.0-15.3). The area under the curve (AUC) predicted by ΔIAP for extubation failure was 0.721, the cutoff value was 31mmHg with 82.8% sensitivity and 48.6% specificity. There were no significant differences in the duration of MV, length of ICU stay, and death in ICU of the three groups of patients (all P>0.05).ConclusionsThe ΔIAP has good reference value for predicting extubation failure, which is negatively correlated with the risk of extubation failure in patients with MV. For MV patients with ΔIAP≤31mmHg, they may have higher risk of extubation failure, early alert and interventions are highlighted for those patients.

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Tracheal extubation in children: Planning, technique, and complications

Cited by 27 publications

References 36 publications

Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia—Part 2: Anesthesia‐related risk and treatment options

Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia—Part 2: Anesthesia‐related risk and treatment options

Ventilation in pediatric anesthesia: A French multicenter prospective observational study (PEDIAVENT)

Intra-abdominal pressure for predicating extubation failure in mechanically ventilated patients: it does work

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