Prediction of extubation failure in newborns, infants and children: brief report of a prospective (blinded) cohort study at a tertiary care paediatric centre in India.

Bedangshu Saikia,Vishnubhatla Sreenivas,Nirmal Kumar

doi:10.1186/s40064-015-1607-1

Bedangshu Saikia, Vishnubhatla Sreenivas + Show 1 more

Open Access

https://doi.org/10.1186/s40064-015-1607-1

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Abstract

BackgroundExtubation failure (EF), defined as need for re-intubation within 24–72 h, is multifactorial. Factors predicting EF in adults generally are not useful in children.ObjectiveTo determine the factors associated with EF and to facilitate prediction of EF in mechanically ventilated infants and children less than 12 years of age.Material and MethodsDesign Prospective cohort study. Setting PICU and NICU of a multispecialty tertiary care institute. Patients All consecutive newborns, infants and children, who remained on the ventilator for more than 12 h, were included. Patients with upper airway obstruction, neuromuscular disorders, complex anatomic malformations, accidental extubation, tracheostomy or death before extubation were excluded. Methods The pre-extubation clinical, laboratory and ventilatory parameters were collected for 92 cases over a one and half year period. The EF rate was calculated for each variable using STATA 9. All the treating physicians were blinded to the data collection procedure.Measurements and ResultsDemographics were comparable between the extubation success and EF groups. Respiratory failure was the main cause requiring ventilation (46.74 %, 95 % CI 0.37–0.57) as well as EF (30.23 %, 95 % CI 0.08–0.23). 76.92 % (95 % CI 0.58–0.89) of patients that failed extubation had alterations in respiratory effort, 38.46 % (95 % CI 0.22–0.57) each had either poor or increased respiratory effort. Poor cough reflex (p = 0.001), thick endotracheal secretions (p = 0.02), failed spontaneous breathing trial (SBT) (p = 0.001) and higher rapid shallow breathing index (RSBI) (p = 0.001) were found to be associated with EF.ConclusionsPaediatric EF is multifactorial. Increased or poor respiratory effort and failed SBT are potential factors in deciding re-intubation. Increased RSBI, poor cough reflex and thick.

Highlights

Extubation failure (EF), defined as need for re-intubation within 24–72 h, is multifactorial
Measurements and Results: Demographics were comparable between the extubation success and EF groups
Two hundred and eleven infants and children were ventilated during the study period. 119 patients could not be included into the study (38 did not meet inclusion criteria, 46 died while on ventilator, 19 left hospital against medical advice and 16 patients referred out). 92 patients were included into the study; 66 patients successfully extubated whereas 26 patients failed extubation

Summary

Introduction

Extubation failure (EF), defined as need for re-intubation within 24–72 h, is multifactorial. Factors predicting EF in adults generally are not useful in children. Extubation failure (EF) is defined as an inability to sustain spontaneous breathing. Newth et al reported limited guidance on paediatric weaning and extubation from their literature review (Newth et al 2009). Indices developed to predict weaning and extubation success (ES) are no better than clinical judgment (Newth et al 2009). Leclerc and Schindler observed that adult weaning predictors proposed by the Task Force of the American College of Chest Physicians have very poor predictive power in children Leclerc and Schindler observed that adult weaning predictors proposed by the Task Force of the American College of Chest Physicians have very poor predictive power in children (Yang and Tobin 1991; Leclerc et al 2005; Schindler. 2005)

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