(1246) Extubation Readiness in Pediatric Mechanical Ventilation

Introduction: Pediatric patients with acute respiratory failure requiring mechanical ventilation comprise 30-64% of the Pediatric Intensive Care Unit (PICU) beds. Extubation failure (EF) can increase morbidity, mortality, and the cost burden. The utilization of extubation readiness tests (ERT) has increased. However, the tests are still not standardized. We present a single-center study evaluating the accuracy of an ERT model.

Methods: A retrospective case-control study comparing the outcomes of extubation was conducted. Institutional Board Review approved this study. The ERT had a total of 15 components. Those who passed ERT were included in the ERT+ group (22 patients). The patients extubated without ERT, had incomplete ERT, or failed ERT were included in the ERT- group (77). Reintubation within 24 hours of extubation was defined as extubation failure (EF). Statistics tests included Fisher’s exact test for categorical variables, T-test for continuous variables, and logistic regression analysis.

Results: Ninety-nine patients were included in this study. Five patients experienced EF (5.05%). The variables including age, sex, Pediatric Index Mortality-2 score, hospital days, ventilator days, sedation days, number of sedatives required, presence of chronic diseases, ARDS, oxygenation index, oxygen saturation index, Saturation: FiO2 ratio, PEEP and FiO2 on the extubation day, steroid use, diuretic use, presence of multiple organ failure, need for inotropic agent, renal injury, liver dysfunction, spontaneous breathing trial duration, and post-extubation respiratory support were not clinically or statistically significantly different between the groups. The specificity and positive predictive value of ERT was 100%. The sensitivity of ERT was 46.81%, and the negative predictive value was 7.41%.

Conclusions: ERT at our institution helped identify pediatric patients at high risk of extubation failure. Our ERT's 100% positive predictive value and specificity give the clinician significant confidence in extubating the patients. Failing the ERT would allow the clinician to address the failed component and test again before performing an extubation. A structured assessment and thorough evaluation of the extubation readiness of mechanically ventilated pediatric patients are critical in preventing extubation failure.