| 11 th Annual Pediatric Critical Care Colloquium |
| Session/Time | Poster/Thu, 4:30 - 6:30 PM |
| Title | Predictors of Successful Extubation in Infants and Children |
| Author | RR Thiagarajan, MD; RS Watson, MD; LD Martin, MD; SL Bratton, MD; TV Brogan, MD, D Taylor, RRT |
| Affiliation | Department of Anesthesia & Critical Care and Respiratory Care Services, Children's Hospital & Regional Medical Center, University of Washington, Seattle, WA |
| Introduction | Predicticii of successful extubatioti in infaiits and children may help decrease the duration of mechanical ventilation and the incidence of associated complications. Objective criteria to predict successful extubatioii have not been established in iiif-,tiits and children. The objective of fliis study was to evaluate weaniiig indices derived frot-n ttie mechanical ventilator for predicting Successful extubatioti in children. |
| Method | During a 14 i-nontli period, 254 extubation episodes in 227 patients in a pediatric intensive care unit at a Liniversity affiliated children's hospital were prospectively studied. The patient's prii-nary physician i-nade all eXtLibatioii aiid re-iiitubatioii decisions. Demographic data, prextubatioii ventilator settings, and arterial blood gasses were recorded. Oiice the study subject was considered to be ready for extubation, the subject was allowed to breatlie spontaneously on CPAP of 4 cm H20 while respiratory rate (RR), tidal volume (V,), and miiiute ventilation were obtained froi-n the ventilator. Fxtubation failure was defiiied as re-iiitubatioii witiiin 24 hours. Standard statistical tests were used to analyze data. A logistic regression model was used to deteri-nine factors significantly influencing exttibation outcome and to construct a probability table for extubation failure. |
| Result | Significant differences in pre-extubation oxygenation, ventilation and dynamic lung coi-npliatice were noted iii children fiiiiiig extubatioii cot-npared with those children successfully exttibated. Ciii[dren falling extubatioii exhibited rapid respiratory rates and small tidal volumes during spontaneous breathing. Weaning indices predicted successful extubatioii better than failure. The Rapid Sl,,allow Bi-eatliliig (RSS) itidex (RP,/V,) laid [lie best predictive value for successful extubitioii. Viriables 1, r9 ifectiiig extubitl'Oll CLItCO111-- Were duration of ventilation aiid RSB index. |
| Conclusion | Extubation failure in infants and children is multifaxtorial. Successful extubation in infants and children can be reliable predicted using wearing wearing indices derived from the mechanixal ventilator, however, extubation failure is more difficult to predict. |
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