Successful Extubation Research Articles

Accuracy of lung ultrasound in predicting successful extubation in preterm infants born ≤ 25 weeks.

The aim of this study was to examine the predictive value of the lung ultrasound score (LUS) for successful extubation in preterm infants born at ≤25+6 weeks. This was a single-center, prospective cohort study. Preterm infants with gestational age (GA) ≤ 25+6 weeks who received invasive mechanical ventilation (IMV) for ≥72 h were included. Lung ultrasound was performed every day. Multivariate logistic regression analysis was used to evaluate factors that predict extubation outcomes. Ninety-three infants with GA ≤ 25+6 weeks were included. The mean GA was 24.5 ± 1.2 weeks. Extubation failure occurred in 55 (59.1%) neonates, and success occurred in 38 (40.9%) neonates. The LUS was significantly lower in the successful group than in the failed group (24.0 ± 2.5 vs. 32.1 ± 3.1 p < 0.001). Logistic regression analysis showed that LUS was an independent predictor of successful extubation (odd ratio 0.15 [95% CI 0.045-0.508], P = 0.002). The area under the receiver operating characteristic curve was 0.98 (p < 0.001) for LUS, and a cutoff value of ≥ 28 had 94.6% sensitivity and 92.7% specificity in detecting extubation failure. The LUS has good accuracy for predicting successful extubation in extremely preterm infants with GA ≤ 25+6 weeks.

Predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia: A meta-analysis with trial sequential analysis (TSA)

Background and Aims: Accurate prediction of extubation success is crucial in critical care to avoid complications from premature or prolonged mechanical ventilation. Bedside diaphragmatic ultrasonography has emerged as a promising tool for assessing extubation readiness, but its effectiveness requires further validation. This meta-analysis evaluates the effectiveness of this method and uses trial sequential analysis (TSA) to assess evidence reliability and identify the need for further research. Methods: A comprehensive literature search was conducted across PubMed, Medline, Embase, Cochrane CENTRAL, Ovid, ISI Web of Science, and the Wanfang Database from 2014 to 2023. The included studies assessed diaphragmatic ultrasonography for predicting extubation success. Successful extubation is defined as maintaining spontaneous breathing for at least 48 hours post-extubation. Data extraction and quality assessment were performed using a random-effects model. Quality was assessed via the Newcastle-Ottawa Scale (NOS), and publication bias was evaluated through funnel plots and Egger’s test. Cumulative meta-analysis, sub-group analyses, and TSA were used to explore heterogeneity and assess evidence reliability. Results: Fourteen studies were included, demonstrating high quality. Diaphragm excursion (DE) and diaphragm thickening fraction (DTF) were significant predictors of extubation success. The diagnostic odds ratio (DOR) was 4.80 [95% confidence interval (CI): 3.86, 5.97)], with a sensitivity of 81.48% and a specificity of 86.86%. Significant heterogeneity was observed (I 2 =85%, χ2 =87.19, P &lt; 0.00001). TSA indicated that the cumulative evidence was insufficient. Conclusions: Diaphragmatic ultrasound, particularly DE and DTF, is useful for predicting extubation success, but current evidence is inconclusive. Further research is required to confirm these findings.

Analyses of the risk factors of delayed extubation after extended thymectomy in patients with myasthenia gravis

Objective: To explore the risk factors of delayed extubation after expanded thymectomy in patients with myasthenia gravis. Methods: Patients with myasthenia gravis who underwent expanded thymectomy from May 2021 to January 2024 and were admitted to Intensive Care Unit (ICU) after surgery were retrospectively analyzed. Patients were divided in to the delayed extubation and successful extubation according to the length of mechanical ventilation whether exceeding than 48 hours. Multivariable logistics regression was used to explore the risk factors for delayed extubation after expanded thymectomy in patients with myasthenia gravis. Results: A total of 95 patients were included.15 (15.8%) of whom were delayed extubation. Compared with the successful extubation patients, the length of mechanical ventilation (94.0 h vs. 15.5 h, P<0.001), ICU station (7.1 days vs. 1.7 days, P<0.001), and hospitalization station (16.0 days vs. 9.1 days, P<0.001) were significantly prolonged in the delayed extubation patients. Adjusted for age,gender, BMI, clinical classification, pathological classification of thymoma, dose of pyridostigmine preoperative, perioperative pneumonia, preoperative pulmonary dysfunction, SBT passing for the first time, neck lift time greater than 20 seconds, the multivariable logistic regression shown, the risk of delayed extubation increased by 29% (OR=1.290, 95%CI 1.090-1.714), 1% (OR=1.009, 95%CI 1.002-1.034), 3.9-fold (OR=4.977, 95%CI 1.486-10.939), and 64% (OR=1.635, 95%CI 1.396-2.682) for every 60 mg/day increase in preoperative dose of pyridostigmine, pathological classification of thymoma, perioperative pneumonia, and preoperative pulmonary dysfunction, respectively. Neck lift time greater than 20 seconds can reduce the risk of delayed extubation 48% (OR=0.524, 95%CI 0.322-0.794). Conclusion: Preoperative administration of a large dose of pyridostigmine, pulmonary dysfunction, pathological classification of thymoma, and perioperative pneumonia were risk factors for delayed extubation after thymectomy in these patients. And neck lift time greater than 20 seconds decreased the risk of delayed extubation. In the clinical practice,for high risk of MG patients with delayed extubation, the neck lifting test may be used to assess muscle strength and reduce the occurance of tracheal reintubation and its advise effects.

A Scoping Review of Factors Associated with Delayed Extubation in Post Cardiac Surgery Patients.

Delayed extubation (DE) after cardiac surgery is associated with high morbidity, mortality, increased length of stay in the intensive care unit, and hospital costs. Various studies have identified factors that influence the occurrence of DE in patients after cardiac surgery, but no review has systematically synthesized the results. This review aimed to identify the influencing factors and the leading causes of DE in patients after cardiac surgery. This scoping review uses the framework developed by Arksey and O'Malley (2005). Literature was searched through four databases: PubMed, Scopus, Science Direct, and CINAHL, and two search engines, Sage and Google Scholar, accessed on October 20, 2024. The articles analyzed met the inclusion criteria, such as full-text articles in English, published from 2014-2024, with case-control, cross-sectional, longitudinal, and cohort study designs and had good quality as assessed using the Joanna Briggs Institute critical appraisal checklist. Data was synthesized using thematic analysis. Eight articles with a total of 13801 participants were included in this review. The prevalence of DE after cardiac surgery ranged from 13.6% to 91.9%. The factors affecting DE were categorized into preoperative, intraoperative and postoperative. The factors most commonly reported to influence ED include preoperative factors (age ≥ 60 and EF < 50%), intraoperative factors (duration of surgery ≥7hours, use of IABP and sedatives), and postoperative factors (BNP≥806 pg/mL). The leading causes of DE after cardiac surgery are hemodynamic instability requiring increased inotropes (33.51%), reduced level of consciousness or drowsiness (31.91%), and postoperative bleeding (20.74%). The process of extubation is a crucial phase in postoperative care. By comprehending the elements that impact DE, healthcare providers can effectively allocate medical resources to enhance the success of weaning, extubation, and recovery following cardiac surgery. Consequently, further research focusing on DE is essential, particularly in patients who have undergone cardiac surgery.

Bedside diaphragmatic ultrasonography for extubation success in critically ill patients: IJA Infographics

Bedside diaphragmatic ultrasonography for extubation success in critically ill patients: IJA Infographics

Respiratory Severity Score (RSS): A Predictive Tool for Successful Extubation in Preterm Neonates

Introduction: The coexistence of immature lungs, poor respiratory drive, overly compliant chest wall, and surfactant deficiency in preterm neonates, leads to dependency on mechanical ventilation during the first days of life. Respiratory Severity Score (RSS) is a readily available, simple and non-invasive extubation failure prediction tool. Objective This study aims to evaluate the utility of pre-extubation RSS as a tool for predicting successful extubation among preterms. Methods and Analysis: This was a retrospective study with a duration of two years started after obtaining clearance from the Institutional Ethics Committee. All preterm neonates ventilated in NICU were included in the study. The hospital unit number was noted and the respective patient records were procured from the hospital records department. Demographic data were recorded from the files. Pre-extubation RSS was calculated. Other findings related to clinical review such as duration of invasive and non-invasive ventilation, surfactant requirement, intraventricular hemorrhage (IVH), early and late-onset sepsis, length of hospital stay (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) mortality data etc. were also recorded. The age, time of extubation and weight of those babies who underwent planned extubation were also recorded. Results: The RSS and RSS/kg were significantly higher among the neonates who failed extubation ( P &lt; .001). The Area under curve (AUC) for RSS and RSS/kg was 0.921 and 0.85, respectively. There was a significantly higher proportion of morbidities such as late-onset sepsis ( P = .046), grade ≥3 IVH ( P = .004) and ROP ( P = .043) observed among the neonates with extubation failure. The prevalence of in-hospital mortality was observed only among neonates with extubation failure which was statistically significant ( P &lt; .001). Conclusion: This study shows that pre-extubation RSS is an excellent tool for predicting successful extubation and is more accurate than RSS/kg. RSS could be a useful tool for clinicians to assess readiness of extubation. However, more prospective, multicentric studies are necessary to validate the generalizability of RSS.

Clinical study on the predictive utility of high flow CPAP in weaning from prolonged mechanical ventilation in critical paediatric surgery patients.

Weaning paediatric patients from mechanical ventilation (MV) often results in extubation failure (EF) (14%-22%) and 2% of patients will require tracheostomy (2%). We performed an observational study in 115 critically ill patients in whom a novel high-flow CPAP (CPAP-ANRI) system was connected to the tracheal tube during ventilation (CPAP + TI). After extubation, the same system was connected to various interfaces. Mean (± SD) age was 31 ± 49 months, PRISM-III score was 2.9 ± 2.4, and duration of intermittent positive pressure ventilation with tracheal intubation (IPPV + TI) was 6 ± 5.6 days followed by CPAP + TI for 1.4 ± 1.7 days. The initial rate of EF was 10.4% for either haemodynamic (n = 4) or respiratory (n = 8) reasons, although the final rate of EF requiring tracheostomy was only 0.8%. After progressing from IPPV + TI to CPAP + TI, PO2/FiO2 values in successfully extubated patients immediately increased by 27% (p < 0.0003) vs only 13% (p > 0.3) in patients presenting EF. Switching to CPAP + TI increased the percentage of patients with pO2/FiO2 > 200, particularly in patients with heart disease, in whom >30% increase in pO2/FiO2 over baseline had a positive predictive value for successful extubation (AUC = 0.708; p = 0.056). The CPAP-ANRI device is a simple respiratory aid that is highly effective in optimizing cardiopulmonary interaction to facilitate weaning from MV and identifying most cases in which extubation is likely to be successful.

Best practice peri-extubation bundle reduces neonatal and infant extubation failure after cardiac surgery.

Extubation failure after neonatal cardiac surgery is associated with increased intensive care unit length of stay, morbidity, and mortality. We performed a quality improvement project to create and implement a peri-extubation bundle, including extubation readiness testing, spontaneous breathing trial, and high-risk criteria identification, using best practices at high-performing centers to decrease neonatal and infant extubation failure by 20% from a baseline of 15.7% to 12.6% over a 2-year period. Utilising the transparency of the Pediatric Cardiac Critical Care Consortium database, five centres were identified as high performers, having better-than-expected neonatal extubation success rates with the balancing metric of as-expected or better-than-expected mechanical ventilation duration. Structured interviews were conducted with cardiac intensive care unit physician leadership at the identified centers to determine centre-specific extubation practices. Data from those interviews underwent qualitative content analysis which was used to develop a peri-extubation bundle. The bundle was implemented at a single-centre 17-bed cardiac intensive care unit. Extubation failure, defined as reintubation within 48 hours of extubation for anything other than a procedure, ventilator days and bundle compliance was tracked. There was a 41.4% decrease in extubation failure following bundle implementation (12 failures of 76 extubations pre-implantation; 6 failures of 65 extubations post-implementation). Bundle compliance was 95.4%. There was no difference in ventilator days (p = 0.079) between groups. Implementation of a peri-extubation bundle created from best practices at high-performing centres reduced extubation failure by 41.4% in neonates and infants undergoing congenital heart surgery.

Serial sonographic assessment of diaphragmatic atrophy and lung injury patterns in mechanically ventilated preterm infants to predict extubation failure: a prospective observational study.

In this cohort of preterm infants, lung ultrasound score has proved to be a stronger predictor of successful extubation compared to diaphragmatic thickness. • Ultrasonographic assessment of the diaphragm and lungs is a sensitive tool in diagnosis of ventilator induced diaphragmatic atrophy and lung injury in preterm infants. Accuracy of lung and diaphragmatic ultrasound in predicting extubation outcome in preterm infants is questionable. • A pattern of progressive decline in diaphragmatic thickness was associated with a concomitant pattern of increase in the lung ultrasound score in mechanically ventilated preterm infants. Lung ultrasound score has proved to be a stronger predictor of successful extubation compared to diaphragmatic thickness.

Closed-loop automated oxygen control in late preterm and term, ventilated infants: A randomised controlled trial.

To compare the time spent above the target oxygen saturation range (SpO2 > 96%) and the duration of supplemental oxygen between ventilated infants receiving closed-loop automated oxygen control (CLAC) or manual oxygen control in late preterm and term ventilated infants. Infants were randomised to receive CLAC or manual oxygen control from recruitment and within 24 h of mechanical ventilation until successful extubation. Forty infants with a median (IQR) gestational age of 37.4 (35.9-38.5) weeks were studied at a corrected postmenstrual age of 37.6 (36.0-38.7) weeks. In infants randomised to CLAC (n = 18) the time spent above the target oxygen saturation range was reduced by 20% (p < 0.001), and the time spent in the target range (92%-96%) was increased by 32% (p < 0.001) and the time spent in hyperoxia was reduced (p = 0.003). CLAC reduced the time spent in hypoxemia (SpO2 < 85%) (p = 0.017) and there were fewer manual adjustments to the inspired oxygen concentration (FiO2) (p < 0.001). There was no significant difference in the duration of supplemental oxygen (p = 0.271). CLAC in ventilated infants born at or near term was associated with reduced time spent in hyperoxemia, more time spent in the target oxygen range, and fewer manual adjustments to the FiO2.

The efficacy of P0.1-guided sedation protocol in critically ill patients receiving invasive mechanical ventilation: A randomized controlled trial

Background: Mechanical ventilation is a lifesaving treatment in patients with acute respiratory failure. Despite optimal support, some patients still exhibit excessive respiratory drive, leading to patient self-inflicted lung injury (P-SILI) and diaphragmatic dysfunction. Sedation and muscle relaxants are commonly used to reduce respiratory efforts and manage patient-ventilator asynchrony (PVA). Conventionally, sedative drugs are adjusted based on the sedation level assessed by the Richmond Agitation-Sedation Scale (RASS), which may not correlate with the patient’s respiratory drive. Drop in airway pressure at the first 100 milliseconds of the beginning of the inspiration after the end-expiratory occlusion (P0.1) is a simple and reliable method of respiratory drive monitoring by mechanical ventilation at the bedside and may be the more suitable sedation target. Objectives: To assess the efficacy of a sedation protocol targeting optimal P0.1 and RASS score compared to conventional sedation strategy in patients requiring invasive mechanical ventilation in the medical intensive care units in terms of successful extubation. Methods: This is an open-labeled, single-center, randomized controlled trial conducted in medical intensive care units at a tertiary care hospital in Bangkok, Thailand. We randomly allocated mechanically ventilated patients in a 1:1 ratio to receive a sedation protocol targeting both optimal respiratory drive measured by P0.1 (intervention group) and light sedation (RASS 0 to -2) or standard of care (control group targeting RASS alone). The primary outcome is the rate of successful extubation within 14 days after randomization. Hypothesis: We hypothesize that sedation protocol targeting optimal P0.1 and light sedation will increase the rate of successful extubation at 14 days in mechanically ventilated patients compared to conventional sedation strategy. Conclusions: This study aims to evaluate the efficacy of a sedation protocol using P0.1 measurement to monitor and target optimal respiratory drive, in conjunction with sedation scores, in critically ill patients receiving invasive mechanical ventilation. Ethics and dissemination: This study protocol was approved by the Human Research Protection Unit of the Faculty of Medicine, Siriraj Hospital, Mahidol University (Certificate of Approval no. Si 915/2023). Trial registration: NCT06203405

Abstract 4141460: Exploring Novel Data-Driven Clustering Methods for Uncovering Patterns in Longitudinal Neonatal Postoperative Temperature Measurements

Introduction: Neonatal hypothermia (&lt; 36.5 o C) after CPB is considered benign despite lack of evidence on its prognostic significance. Question: Are group-based trajectory modeling (GBTM), k-means, and self-organizing map (SOM) clustering approaches clinically useful for evaluating their associations with important outcomes? Aims: Identify distinct postoperative temperature trajectories in neonates after CPB using novel machine learning (ML) clustering methods, corroborate findings, and evaluate prognostic value on outcomes. Methods: Secondary cohort analysis of prospectively collected data. Accessed data from a single pediatric referral center's CardioAccess registry consistent of postoperative neonates with congenital heart defects (CHD). 48-hourly postoperative temperature measurements were extracted from patient records. GBTM, SOM, and k-means clustering identified cluster membership and model fit was optimized for 3 clusters based on existing knowledge. The primary outcome was a complication composite of severe bleeding, illness severity, cardiac arrest, arrhythmia, delayed first successful extubation, prolonged ICU LOS, very poor weight gain, and 30-day mortality. 3 data driven techniques were compared and then associated with outcomes using adjusted multivariable binary logistic regression (LR). Results: 450 neonates ≥ 34 weeks gestation undergoing CPB between 2015 and 2019 met inclusion criteria. GBTM, SOM, and k-means clustering identified temperature group assignment for 3 clusters: 1) persistent hypothermia (n=38, 9% vs. n=49, 11% vs. n=40, 9%), 2) resolving hypothermia (n=233, 51% vs. n=227, 50% vs. n=147, 33%), and 3) normothermia (n=179, 40% vs. n=174, 39% vs. n=263, 58%). Concordance of techniques showed strong agreement between GBTM and SOM (kappa= 0.92). The kappa test comparing GBTM and k-means assignment was 0.41, indicating a weak to moderate agreement. After adjustment in the multivariable binary LR, persistently hypothermic neonates compared to normothermic neonates were associated with higher odds of the complication composite outcome in the GBTM (OR: 2.8 [1.0-7.3], p 0.041) and SOM (OR: 2.3 [1.0-5.4], p 0.045) models, but not the k-means model (OR: 1.4 [0.7-3.1], p 0.38). Conclusion: Exploring concordance between different unsupervised ML techniques, shows that neonatal temperature after CPB follows distinct postoperative trajectories, and those exhibiting a persistent hypothermia trend are at higher risk of adverse outcomes.

Elective extubation during skin-to-skin care in preterm newborns is safe and well-tolerated.

To evaluate the safety and tolerance of elective extubations in preterm newborns (PNB) during skin-to-skin care (SSC) compared to those performed in an incubator. Retrospective observational study including 142 extubations in 93 PNB with gestational age (GA) <32 weeks and/or birth weight (BW) <1500 g performed during the first 2 months of life. Safety, tolerance and extubation success at 72 h were assessed. The median GA was 25.4 weeks in the SSC group versus 26.6 weeks in the incubator group (p = 0.002). The median BW was 700 grams and 880 grams, respectively (p = 0.001). In total, 60 extubations (42.3%) were performed during SSC in 42 PNB and 82 in incubator in 69 PNB. No incidents related to extubation during SSC were recorded. The extubation success rate was 80% in SSC versus 79.3% in incubator (p = 0.915). Most failures occurred between 3 and 24 h after extubation. There were no observed differences in heart rate or FiO2 variations between the groups, nor in the need to escalate respiratory support at 24 h after extubation (SSC 15% vs. incubator 12.2%, p = 0.628). Extubation during SSC is a feasible, safe and well-tolerated practice, while allowing PNB to experience the benefits from SSC.

Lung ultrasound score and diaphragm ultrasound in weaning from mechanical ventilation: are they different in patients with and without COVID-19?

To compare pre-extubation physiological characteristics and ultrasound variables between patients intubated for COVID-19 compared to a clinical population and those intubated for other reasons. This was a secondary analysis of a prospective cohort study of patients undergoing invasive mechanical ventilation (IMV) for more than 48 h. Patients were divided into two groups: those intubated for COVID-19-induced ARDS and those intubated for other clinical reasons. Ultrasound assessment of lung and diaphragm function was performed before extubation. The results were compared between the two groups of patients. In comparison with the patients without COVID-19, those with the disease were younger (a median age of 58 [46-76] years vs. a median age of 75 [69-85] years; p = 0.01), had fewer comorbidities (a median Charlson Comorbidity Index of 2 [1-4] vs. a median Charlson Comorbidity Index of 5 [4-6]; p < 0.01), and were less severely ill at admission (a median APACHE II score of 9 [8-14] vs. a median APACHE II score of 18 [13-22]; p < 0.01). In addition, the median duration of IMV was longer in the COVID-19 patients (11 [9-23] days vs. 6 [3-8] days; p < 0.01). Although extubation success rates were similar between the COVID-19 and non-COVID-19 groups (22 [71%] vs. 35 [77.8%]), median lung ultrasound score differed between the two groups (23 [18-25] vs. 15 [11-18]; p < 0.01), as did median diaphragmatic excursion (2.1 [1.7-2.4] vs. 1.7 [1.2-2.0]; p < 0.01). Although patients with COVID-19 requiring ventilatory support are younger and have fewer comorbidities than those intubated for other clinical reasons, they experience longer hospital stays. Although lung ultrasound score can differ between patients with and without COVID-19, these differences do not significantly translate into extubation success rates. Therefore, the utility of ultrasound scores in weaning COVID-19 patients from IMV needs further study.

Short (30 Minutes) versus long (120 Minutes) spontaneous breathing trial among patients with difficult weaning (SL-SBT Trial)

BackgroundThe optimal duration of spontaneous breath trial (SBT) for patients with difficult extubation from mechanical ventilation is unknown. ObjectiveThis study compared extubation success with two different durations of SBT in patients who failed their first SBT. MethodsThis single-center randomized controlled trial included adults on mechanical ventilation who had failed their first SBT. The participants were randomized to receive pressure support ventilation (PSV) for either 30 or 120 min. Our primary outcome was the rate of successful extubation (without reintubation within 48 h). Key secondary outcomes were the length of intensive care unit (ICU) and hospital stay and in-hospital and 90-day mortality. ResultsA total of 119 patients (62.2 % male) with a mean age of 53.9 years were randomized to undergo SBT for either 30 min (n = 60) or 120 min (n = 59). Among them, 82.4 % of patients had hypercapnic respiratory failure. The rates of successful extubation were similar with SBT of 30 min and 120 min (58.3 % vs. 59.3 %, respectively; p = 0.91). There were no significant differences between the two groups in terms of the durations of ICU and hospital stay or in-hospital and 90-day mortality. ConclusionsExtubation success and other clinically important outcomes were comparable between short (30 min) and long (120 min) SBT in difficult weaning. A 30-minute SBT may be acceptable in this setting.

Effect of pulmonary rehabilitation training in patients with tracheostomy and non-mechanical ventilation: a prospective cohort study

To explore the clinical application effects of early pulmonary rehabilitation training based on bundle airway management in patients with tracheostomy and non-mechanical ventilation. Used convenience sampling, adult patients who underwent tracheostomy and non-mechanical ventilation admitted to Fenyang Hospital of Shanxi Province from January 2022 to May 2023 were enrolled. Patients were divided into control group and observation group based on their admission dates. The control group implemented bundle airway management based on the Airway care for patients with tracheostomy and non-mechanical ventilation. The observation group received additional pulmonary rehabilitation training implemented by a specialized respiratory rehabilitation team. The primary outcomes included hospital stay duration, improvement rate of muscle strength, diaphragmatic mobility, and successful extubation rate. Secondary outcomes included the incidence of pulmonary infection, improvement rate of self-care ability, and the duration of tracheal tube placement in extubated patients. A total of 41 patients were included in the control group and 39 patients in the observation group. There were no significantly differences in gender, age, first diagnosis of disease, and activities of daily living (ADL) score at admission between the two groups, indicating balanced baseline data and comparability. Compared with the control group, the observation group had a significantly shorter hospital stay (days: 38.33±17.58 vs. 51.34±27.06), a higher improvement rate of muscle strength (76.92% vs. 39.02%), greater diaphragmatic mobility (cm: 1.86±0.64 vs. 1.44±0.57), and a higher success rate of tracheostomy tube extubation (38.46% vs. 17.07%), the duration of tracheal tube placement in successfully extubated patients was significantly reduced (days: 33.26±17.87 vs. 50.60±21.98), with all differences being statistically significant (all P < 0.05). Although the improvement rate of ADL score (56.41% vs. 36.59%) and the incidence of pulmonary infection (5.13% vs. 7.32%) in the observation group were better than those in the control group, but there were no differences (both P > 0.05). The addition of pulmonary rehabilitation training in bundle airway management can enhance exercise tolerance, improve respiratory function, promote sputum clearance, increase successful extubation rates, shorten hospital stays, and facilitate early recovery in patients with tracheostomy and non-mechanical ventilation.

Diaphragmatic Dynamics Assessed by Bedside Ultrasound Predict Extubation in the Intensive Care Unit: A Prospective Observational Study.

This study aims to evaluate the predictive value of bedside ultrasound evaluation of diaphragmatic dynamics in determining successful extubation outcomes for patients eligible for weaning. This prospective observational study was conducted on patients who were mechanically ventilated and ready for weaning during the spontaneous breathing trial (SBT). The diaphragm contraction and motion-related parameters of patients such as end inspiratory diaphragm thickness (DT-insp), end respiratory diaphragm thickness (DT-exp), diaphragm thickening fraction (DTF), diaphragmatic thickening fraction rapid shallow breathing index (DTF-RSBI), diaphragmatic excursion (DE), diaphragmatic excursion rapid shallow breathing index (DE-RSBI) were recorded and the association with failure in ventilatory extubation was analyzed. A receiver operating characteristic (ROC) curve was conducted to analyze the prediction of successful weaning. Out of 95 patients, 14 (14.74%) died, and 68 (71.58%) were successfully extubated. There were significant differences between the two groups in all parameters except DT-exp. The results indicated that duration of mechanical ventilation (OR = 0.850, 95% CI: 0.770-0.938, P = 0.001), DTF (OR = 1.214, 95% CI: 1.108-1.330, P = 0.000), DTF-RSBI (OR = 0.917, 95% CI: 0.880-0.954, P = 0.000), DE (OR = 127.02, 95% CI: 15.004-1075.291, P = 0.000), DE-RSBI (OR = 0.752, 95% CI: 0.657-0.861, P = 0.000) had predictive value for weaning. DTF and DE had a high sensitivity of 91.18%, 100%, respectively. Whereas, duration of mechanical ventilation, DTF-RSBI, DE-RSBI showed a high specificity of 81.48,85.19%, 81.48%. Considering all the above factors, the sensitivity was 88.24% and the specificity was 88.89%. Bedside ultrasound assessment of diaphragmatic parameters enables the detection of diaphragmatic dysfunction, thus proving valuable in predicting extubation success and facilitating a favorable weaning outcome.

Predictive model development for premature infant extubation outcomes: development and analysis.

Given the knowledge of the damage caused by prolonged invasive mechanical ventilation in premature newborns, withdrawing this support as quickly as possible is important to minimize morbidity. The aim of this study was to analyze the variables associated with extubation outcomes and to develop a predictive model for successful extubation in premature newborns. Data were obtained from a multicenter study involving six public maternity hospitals. The variables with the highest correlation to the extubation outcome were used to construct the predictive model through data analysis and machine learning methods, followed by training and testing of algorithms. Data were collected from 405 premature newborns. The predictive model with the best metrics was trained and tested using the variables of gestational age, birth weight, weight at extubation, congenital infections, and time on invasive mechanical ventilation, based on 393 samples according to the extubation outcome (12 were discarded due to irretrievable missing data in important attributes). The model exhibited an accuracy of 77.78%, sensitivity of 79.41%, and specificity of 60%. These variables generated a predictive model capable of estimating the probability of successful extubation in premature newborns. Prolonged use of invasive mechanical ventilation in preterm newborns increases morbidity/mortality rates, emphasizing the importance of early withdrawal from invasive ventilatory support. However, the decision to extubate lacks tools with higher extubation outcome precision. The use of artificial intelligence through the construction of a predictive model can assist in the decision-making process for extubating preterm newborns based on real-world data. The implementation of this tool can optimize the decision to extubate preterm newborns, promoting successful extubation and reducing preterm newborns exposure to adverse events associated with extubation failure.

Combined lung and diaphragm ultrasound predicts extubation outcomes in ARDS: a prospective study

BackgroundExtubation failure is a crucial issue for acute respiratory distress syndrome (ARDS). Ultrasound of the lung and diaphragm is individually valuable for predicting extubation outcomes. We aimed to determine whether combined lung and diaphragmatic ultrasound could improve the accuracy of predicting the extubation of ARDS patients.MethodsThis was a prospective cohort study of ARDS patients who were ready for extubation. The lung ultrasound score (LUS), diaphragmatic displacement (DD), diaphragm thickening fraction (DTF), and diaphragmatic-rapid shallow breathing index (D-RSBI) were measured at the end of the spontaneous breathing trial. The primary outcome was extubation success. Logistic regression was used to combine these indicators, and the predictive performance of the single and combined indicators was evaluated through receiver operating characteristic (ROC) curves, the Hosmer–Lemeshow Ĉ‐test, and the Brier score. Multivariate logistic regression was used to determine the association between combined ultrasound indicators and extubation success.ResultsThis study enrolled 132 eligible patients from January 2019 to December 2022. A total of 71% (94/132) of patients were successfully extubated from mechanical ventilation. The combination of LUS and D-RSBI had the largest area under the ROC curves, the lowest Brier score, and the greatest calibration. After formula transformation, LUS + 2.43 × D-RSBI ≤ 14.273 was significantly associated with extubation success in ARDS patients.ConclusionsIn ARDS patients receiving mechanical ventilation, the combination of LUS and D-RSBI was more accurate than a single parameter alone in predicting extubation outcomes. This combined approach could help refine extubation protocols in critical care.Clinical trial registration This study is registered online with the Chinese Clinical Trial Registry (ChiCTR), http://www.chictr.org.cn, ChiCTR1800019340 (Registration time: 2018/11/06).

Frequency of Screening and Spontaneous Breathing Trial Techniques

The optimal screening frequency and spontaneous breathing trial (SBT) technique to liberate adults from ventilators are unknown. To compare the effects of screening frequency (once-daily screening vs more frequent screening) and SBT technique (pressure-supported SBT with a pressure support level that was >0-≤8 cm H2O and a positive end-expiratory pressure [PEEP] level that was >0-≤5 cm H2O vs T-piece SBT) on the time to successful extubation. Randomized clinical trial with a 2 × 2 factorial design including critically ill adults who were receiving invasive mechanical ventilation for at least 24 hours, who were capable of initiating spontaneous breaths or triggering ventilators, and who were receiving a fractional concentration of inspired oxygen that was 70% or less and a PEEP level of 12 cm H2O or less. Recruitment was between January 2018 and February 2022 at 23 intensive care units in North America; last follow-up occurred October 18, 2022. Participants were enrolled early to enable protocolized screening (more frequent vs once daily) to identify the earliest that patients met criteria to undergo pressure-supported or T-piece SBT lasting 30 to 120 minutes. Time to successful extubation (time when unsupported, spontaneous breathing began and was sustained for ≥48 hours after extubation). Of 797 patients (198 in the once-daily screening and pressure-supported SBT group, 204 in once-daily screening and T-piece SBT, 195 in more frequent screening and pressure-supported SBT, and 200 in more frequent screening and T-piece SBT), the mean age was 62.4 (SD, 18.4) years and 472 (59.2%) were men. There were no statistically significant differences by screening frequency (hazard ratio [HR], 0.88 [95% CI, 0.76-1.03]; P = .12) or by SBT technique (HR, 1.06 [95% CI, 0.91-1.23]; P = .45). The median time to successful extubation was 2.0 days (95% CI, 1.7-2.7) for once-daily screening and pressure-supported SBT, 3.1 days (95% CI, 2.7-4.8) for once-daily screening and T-piece SBT, 3.9 days (95% CI, 2.9-4.7) for more frequent screening and pressure-supported SBT, and 2.9 days (95% CI, 2.0-3.1) for more frequent screening and T-piece SBT. An unexpected interaction between screening frequency and SBT technique required pairwise contrasts that revealed more frequent screening (vs once-daily screening) and pressure-supported SBT increased the time to successful extubation (HR, 0.70 [95% CI, 0.50-0.96]; P = .02). Once-daily screening and pressure-supported SBT (vs T-piece SBT) did not reduce the time to successful extubation (HR, 1.30 [95% CI, 0.98-1.70]; P = .08). Among critically ill adults who received invasive mechanical ventilation for more than 24 hours, screening frequency (once-daily vs more frequent screening) and SBT technique (pressure-supported vs T-piece SBT) did not change the time to successful extubation. However, an unexpected and statistically significant interaction was identified; protocolized more frequent screening combined with pressure-supported SBTs increased the time to first successful extubation. ClinicalTrials.gov Identifiers: NCT02399267 and NCT02969226.