Accuracy of an Extubation Readiness Test in Predicting Successful Extubation in Children With Acute Respiratory Failure From Lower Respiratory Tract Disease

Published on Jan 1, 2017in Critical Care Medicine6.971
· DOI :10.1097/CCM.0000000000002024
Edward Vincent S. Faustino12
Estimated H-index: 12
Rainer Gedeit16
Estimated H-index: 16
+ 3 AuthorsMartha A. Q. Curley36
Estimated H-index: 36
Objective:Identifying children ready for extubation is desirable to minimize morbidity and mortality associated with prolonged mechanical ventilation and extubation failure. We determined the accuracy of an extubation readiness test (Randomized Evaluation of Sedation Titration for Respiratory Failur
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Rationale: Subglottic edema is the most common cause of pediatric extubation failure, but few studies have confirmed risk factors or prevention strategies. This may be due to subjective assessment of stridor or inability to differentiate supraglottic from subglottic disease.Objectives: Objective 1 was to assess the utility of calibrated respiratory inductance plethysmography (RIP) and esophageal manometry to identify clinically significant post-extubation upper airway obstruction (UAO) and diffe...
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Severe respiratory failure develops in some infants with bronchiolitis because of a complex pathophysiologic process involving increased airways resistance, alveolar atelectasis, muscle fatigue, and hypoxemia due to mismatch between ventilation and perfusion. Nasal CPAP and high-flow nasal cannula (HFNC) oxygen may improve the work of breathing and oxygenation. Although the mechanisms behind these noninvasive modalities of respiratory support are not well understood, they may help infants by way...
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Context:There is absence of evidence-based guidelines to determine extubation readiness in the pediatric intensive care unit (PICU).Objective:Evaluate our practice of determining extubation readiness based on physician judgment of preextubation ventilator settings, blood gas analysis, and other factors potentially affecting extubation outcome.Design:Prospective cohort study from August 2010 to April 2012.Setting:Academic, multidisciplinary PICU.Patients:A total of 319 PICU patients undergoing fi...
11 CitationsSource
#1Martha A. Q. Curley (UPenn: University of Pennsylvania)H-Index: 36
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Importance Protocolized sedation improves clinical outcomes in critically ill adults, but its effect in children is unknown. Objective To determine whether critically ill children managed with a nurse-implemented, goal-directed sedation protocol experience fewer days of mechanical ventilation than patients receiving usual care. Design, Setting, and Participants Cluster randomized trial conducted in 31 US pediatric intensive care units (PICUs). A total of 2449 children (mean age, 4.7 years; range...
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Faith, defined as a firm belief in something for which there is no proof, is in contrast to observation and inference, in which we learn and make a conclusion about what the evidence tells us. If we fail to continue to observe and change our conclusions, then one can fall into a practice of faith.
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BACKGROUND: The pediatric literature addressing extubation readiness parameters and strategies to wean from mechanical ventilation is limited. METHODS: We designed a survey to assess the use of extubation readiness parameters among pediatric critical care physicians at academic centers in the United States. RESULTS: The overall response rate was 44.1% (417/945). The majority of respondents check for air leak and the amount of tracheal secretions. Fewer respondents use sedation score, the rapid s...
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Objectives:To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasi
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#1Christopher J. L. Newth (SC: University of Southern California)H-Index: 46
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Last. Carol Nicholson (NIH: National Institutes of Health)H-Index: 22
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Objective A systematic review of weaning and extubation for pediatric patients on mechanical ventilation.
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Purpose:Although several studies assess unplanned extubation (UE) in children, few have addressed determinants of UE and factors associated with reintubation in a case-controlled manner. We aimed to identify the risk factors and outcomes associated with UE in a pediatric intensive care unit.Methods:Cases of UE were randomly matched with control patients at a ratio of 1:4 for age, severity of illness, and admission diagnosis. For cases and controls, we also collected data associated with UE event...
#1Adrienne G. Randolph (Boston Children's Hospital)H-Index: 50
This chapter will provide an overview of strategies for achieving the ultimate goal of discontinuing ventilator support in children with pediatric acute respiratory distress syndrome. Topics covered include how clinicians can determine whether children are ready to be assessed for extubation readiness, the indications for ventilator weaning and which ventilator and patient parameters to evaluate, and use of spontaneous awakening and spontaneous breathing trials. A review of ventilator modes comm...
#1Daniele BonacinaH-Index: 1
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OBJECTIVES: We sought to compare gas exchange, respiratory mechanics, and asynchronies during pressure support ventilation (PSV), sigh adjunct to PSV (PSV SIGH), and neurally adjusted ventilatory assist (NAVA) in hypoxemic infants after cardiac surgery. DESIGN: Prospective, single-center, crossover, randomized physiologic study. SETTING: Tertiary-care pediatric intensive care unit. PATIENTS: Fourteen hypoxemic infants (median age 11.5 days [8.7-74]). INTERVENTIONS: The protocol begins with a 1 h...
#1Makoto Sasaki (YCU: Yokohama City University)
#2Yoshikazu Yamaguchi (YCU: Yokohama City University)H-Index: 3
Last. Takahisa Goto (YCU: Yokohama City University)H-Index: 16
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Background Endotracheal tubes used for neonates are not as resistant to breathing as originally anticipated; therefore, spontaneous breathing trials (SBTs) with continuous positive airway pressure (CPAP), without pressure support (PS), are recommended. However, PS extubation criteria have predetermined pressure values for each endotracheal tube diameter (PS 10 cmH2O with 3.0- and 3.5-mm tubes or PS 8 cmH2O with 4.0-mm tubes). This study aimed to assess the validity of these SBT criteria for neon...
#1Samer Abu-Sultaneh (Riley Hospital for Children)
#2Christopher W. Mastropietro (Riley Hospital for Children)H-Index: 1
Mechanical ventilation is a lifesaving intervention that is used to support patients with acute respiratory failure. Mechanical ventilation however is not without risk. Complications such as ventilator-induced lung injury, ventilator-associated pneumonia, prolonged exposure to narcotics and sedatives, airway trauma, and consequent respiratory muscle weakness have been well described in the literature [1–5]. Because of these risks as well as the associated costs of prolonged intensive care unit (...
#1Martha A. Q. Curley (UPenn: University of Pennsylvania)H-Index: 36
#2Rainer Gedeit (Children's Hospital of Wisconsin)H-Index: 16
Last. David Wypij (Harvard University)H-Index: 66
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Background Few papers discuss the pragmatics of conducting large, cluster randomized clinical trials. Here we describe the sequential steps taken to develop methods to implement the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial that tested the effect of a nurse-implemented, goal-directed, comfort algorithm on clinical outcomes in pediatric patients with acute respiratory failure.
#1Silvia M. HartmannH-Index: 2
#2Robert M DiBlasi (Boston Children's Hospital)H-Index: 15
Both adult and pediatric ICUs have adopted respiratory therapist- or nurse-driven protocols that help advance the care of patients and may improve outcomes. In this issue of Respiratory Care, Krawiec and colleagues[1][1] describe the creation of a spontaneous breathing trial (SBT) protocol and some
#1Conrad Krawiec (Penn State Milton S. Hershey Medical Center)H-Index: 5
#2Dale Carl (Boston Children's Hospital)H-Index: 1
Last. Neal J. Thomas (PSU: Pennsylvania State University)H-Index: 36
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BACKGROUND: Timely ventilator liberation is crucial in the pediatric ICU. In many pediatric ICUs, the decision to initiate weaning is driven by the physician, which may lead to delays in ventilator liberation. The objectives of this quality improvement project were to develop and implement a respiratory therapist (RT)–led protocol for screening for spontaneous breathing trial (SBT) readiness, to test protocol feasibility, and to evaluate its impact on SBT timing. METHODS: A retrospective chart r...
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OBJECTIVES: Establishing protocols to wean mechanical ventilation and assess readiness for extubation, with the goal of minimizing morbidity associated with extubation failure and prolonged mechanical ventilation, have become increasingly important in contemporary PICUs. The aim of this quality improvement initiative is to establish a respiratory therapist-led daily spontaneous breathing trial protocol to standardize extubation readiness assessment and documentation in our PICU. DESIGN: A qualit...
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#2Marcelo Cunio Machado Fonseca (UNIFESP: Federal University of São Paulo)H-Index: 12
BACKGROUND: Cardiovascular collapse is a life-threatening event after unplanned extubations (UEs) in the pediatric ICU (PICU). However, there is a paucity of pediatric studies assessing this complication. We sought to assess the incidence, risk factors, and outcome of cardiovascular collapse after UEs in PICU patients. METHODS: All children who had been mechanically ventilated for ≥12 h were prospectively tracked for UEs over an 8-y period. Subjects were included in the study if they were betwee...