Laham et al.(2121 Laham JL, Breheny PJ, Rush A. Do clinical parameters predict first planned extubation outcome in the pediatric intensive care unit? J Intensive Care Med. 2015;30(2):89-96.)
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SBT |
The success rate in the first attempt at EXT was 91%. The risk factors associated with failure were duration of MV (OR = 2.20; p < 0.0001), pre-EXT corticosteroids (OR = 2.4; p = 0.04) and post-EXT stridor (OR) = 3.4; p < 0.01). Ventilation index ≤ 8 was associated with failure in a patient with 1 day of MV. EXT failure was associated with longer length of ICU stay and increased hospital costs; patients who failed stayed in the ICU 14 days longer (p < 0.0001), with a cost 3.2 times higher (p < 0.0001) than that incurred by patients with successful EXT |
Khemani et al.(2222 Khemani RG, Sekayan T, Hotz J, Flink RC, Rafferty GF, Iyer N, et al. Risk factors for pediatric extubation failure: the importance of respiratory muscle strength. Crit Care Med. 2017;45(8):e798-e805.)
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PiMax, PI/PiMax, RSBI, TTI |
Within 48 hours after EXT, 8.3% of patients were reintubated. The risk factors for reintubation included lower PiMax, longer MV duration, UAO post-EXT, high post-EXT respiratory effort (PRP and TTI) and high post-EXT phase angle. Approximately 35% of the children had a PiMax < 30cmH2O at the time of EXT and were almost three times more likely to be reintubated than those with a PiMax > 30cmH2O (p = 0.006). The reintubation rate was higher in children with a PiMax < 30cmH2O and PRP > 1,000. In children who developed UAO, the reintubation rate was higher in those with a PiMax < 30cmH20 than in those with a PiMax > 30cmH2O (47% versus 15.4%; p = 0.02). |
Riou et al.(2323 Riou Y, Chaari W, Leteurtre S, Leclerc F. Predictive value of the physiological deadspace/tidal volume ratio in the weaning process of mechanical ventilation in children. J Pediatr (Rio J). 2012;88(3):217-21.)
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VD/VT |
NIV was used in four patients who developed RF after EXT; there was no reintubation. Children who required NIV had significantly higher VD/VT than those who did not undergo NIV (p < 0.001). The cutoff value for VD/VT was 0.55, and the area under the ROC curve was 0.86. |
Johnston et al.(2424 Johnston C, de Carvalho WB, Piva J, Garcia PC, Fonseca MC. Risk factors for extubation failure in infants with severe acute bronchiolitis. Resp Care. 2010;55(3):328-33.)
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PiMax, RSBI, load/force balance |
EXT failure occurred in 15% of extubated children. There were no significant differences in blood gas values or MV parameters between the EXT success and failure groups. There was a statistically significant difference between the groups for two risk factors: weight < 4kg and TV < 4mL/kg. The variables with a large area under the curve were minute volume < 0.8mL/kg/minute and PiMax < 50cmH2O. The variables with a small area under the curve were load/force balance > 5 and RSBI > 6.7. |
Foronda et al.(2525 Foronda FK, Troster EJ, Farias JA, Barbas CS, Ferraro AA, Faria LS, et al. The impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: a randomized controlled trial. Crit Care Med. 2011;39(11):2526-33.)
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SBT |
The MV duration was shorter in the test group (3.5 days) than in the control group (4.6 days) (p = 0.0127 (95%CI)). This significant reduction in the test group was not associated with an increase in the EXT failure rate or the use of NIV post-EXT. It represents a 30% reduction in the risk of remaining on MV (risk rate of 0.7) |
Jouvet et al.(2626 Jouvet PA, Payen V, Gauvin F, Emeriaud G, Lacroix J. Weaning children from mechanical ventilation with a computer-driven protocol: a pilot trial. Intensive Care Med. 2013;39(5):919-25.)
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SmartCare™ |
The median weaning duration was 21 hours (range, 3 - 142 hours) in the SmartCare™ group and 90 hours (range 4 - 552 hours) in the usual weaning group (p = 0.007). The reintubation rates and the use of NIV post-EXT with SmartCare™ and in the usual weaning group were 2/15 versus 1/15 and 2/15 versus 2/15, respectively. |