OBJECTIVES Between 10% and 20% of children submitted to mechanical ventilation in the pediatric intensive care unit present extubation failure. Several ventilatory indexes have been proposed to predict extubation failure. The aim of this study was to analyze the accuracy of these indices in predicting successful extubation in children and to evaluate these variables according to the age of the ...

Patients undergoing neurosurgery are predisposed to a variety of complications related to mechanical ventilation (MV). There is an increased incidence of extubation failure, pneumonia, and prolonged MV among such patients. The aim of the present study was to assess the influence of extubation failure and prolonged MV on the following variables: postoperative pulmonary complications (PPC), morta...

OBJECTIVE To evaluate the performance of an extubation readiness test based on a spontaneous breathing trial using pressure support. DESIGN Retrospective chart review. SETTING Pediatric intensive care unit. PATIENTS All infants and children admitted to the pediatric intensive care unit requiring intubation from July 2007 to December 2008 were eligible for this study. INTERVENTIONS Routi...

OBJECTIVE Endotracheal tube air leak pressures are used to predict postextubation upper airway compromise such as stridor, upper airway obstruction, or risk of reintubation. To determine whether the absence of an endotracheal tube air leak (air leak test >/=30 cm H2O) measured during the course of mechanical ventilation predicts extubation failure in infants and children. DESIGN Prospective, ...

In recent years, there has been increasing interest in the use of noninvasive ventilation (NIV) in the post-extubation period to shorten the length of invasive ventilation, to prevent extubation failure, and to rescue a failed extubation. The purpose of this review is to summarize the evidence related to the use of NIV in these settings. NIV can be used to allow earlier extubation in selected ...

Background. Automatic tube compensation (ATC) has been developed to overcome the imposed work of breathing due to artificial airways during spontaneous breathing trials (SBTs). Objectives. This study aimed to assess extubation outcome after an SBT (spontaneous breathing trial) with ATC compared with pressure support ventilation (PSV) and to determine the risk factors for extubation failure. Met...

OBJECTIVES To determine the incidence of extubation failure in preterm newborns with birth weight < 1,250 g extubated to nasal continuous positive airway pressure and to identify the main risk factors associated with the need for reintubation in this population. METHODS A retrospective review of eligible infants admitted and mechanically ventilated between July 2002 and June 2004 was performe...

a study published in the previous issue of Critical Care, Gonçalves and colleagues [1] observed a 33% reduction in re-intubation rate in the study group, due to eff ective management of bronchial secretions. Current evidence favors early implementation of noninvasive mechanical ventilation (NIV) in the post-extubation period to reduce re-intubation, especially in patients with hypercapnic respi...

OBJECTIVES To describe the epidemiology of extubation failure and identify risk factors for its occurrence in a multicenter population of neonates undergoing surgery for congenital heart disease. STUDY DESIGN We conducted a prospective observational study of neonates ≤30 days of age who underwent cardiac surgery at 7 centers within the US in 2015. Extubation failure was defined as reintubatio...

Safe liberation from mechanical ventilation remains a challenge for the critical care physician. Undue prolongation of mechanical ventilation or extubation failure followed by re-intubation is associated with negative outcome. Recent clinical practice guidelines suggest using pressure augmentation during a spontaneous breathing trial (SBT), which would result in more successful SBTs and higher ...