Abstract
Objective Objective tools such as spontaneous breathing trials (SBT) aim to identify patients
ready for extubation and shorten the length of mechanical ventilation (MV). Despite
passing an SBT, patients sometimes are not extubated based on clinicians' subjective
impressions. In this article, we explored the factors that influence the decision
to extubate among pediatric intensivists and their association with objective criteria.
Design This is a single-center prospective observational study.
Setting This study was conducted in an academic, multidisciplinary 20-bed pediatric intensive
care unit (PICU).
Patients The study group involves mechanically ventilated, orally intubated patients admitted
to the PICU from January 1 to June 30, 2019.
Measurements and Main Results Objective clinical data were collected for 650 MV days. Attending surveys about extubation
readiness were completed for 419 (64.5%) MV days and 63 extubation events. Extubation
occurred on 42% of days after passing an SBT. The primary reasons patients who passed
an SBT were not extubated on days were unresolved lung pathology (66.6%) and fluid
overload (37.6%). On days without extubation, there was no association between a specific
reason for not extubating and SBT result (p > 0.05).
Conclusions In this single-center study, the decision to extubate was not strongly associated
with passing an SBT, indicating that clinician impressions, namely unresolved lung
pathology and fluid overload, outweighed objective measures for determining extubation
readiness. To mitigate morbidities and costs associated with unnecessarily prolonged
intubations, a better-defined extubation readiness process is needed to guide the
decision to extubate in the pediatric population.
Keywords
Extubation - mechanical ventilation - spontaneous breathing trial - reintubation -
PICU
