ACCURACY OF AN EXTUBATION READINESS TEST IN PREDICTING SUCCESSFUL EXTUBATION IN CHILDREN WITH ACUTE RESPIRATORY FAILURE FROM LOWER RESPIRATORY TRACT DISEASE
Faustino EV, Gedeit R, Schwarz AJ, Asaro, LA, Wypij D, Curley MA. Crit Care Med 2017;45(1):94-102.
This study was a secondary analysis from the randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial. The aim of this study was to identify children ready for extubation as to minimize morbidity and mortality associated with children with acute respiratory failure from lower respiratory tract disease. This was from a multicenter randomized trial that included 17 pediatric intensive care units. The study participants were children 2 weeks to 17 years of age receiving mechanical ventilation for lower respiratory tract disease (n = 1042).
The study intervention was extubation readiness test for spontaneous breathing with oxygenation index less than or equal to 6, placed on FIO2 of 0.50 positive on-expiratory pressure of 5 cm H2O and pressure support; 43% (444 patients) passed their first extubation readiness test. Of these, 66% (295 patients) were intubated within 10 hours of starting the extubation readiness test, and 272 remained successfully intubated. The median time for extubation with an extubation readiness test was 12:15 hours, compared with 14:54 hours for extubation without an extubation readiness test within 10 hours.
The researchers concluded that for children with acute respiratory failure from lower respiratory tract disease an extubation readiness test should be considered a least daily if the oxygenation index is less than or equal to 6. If the extubation readiness test is successful, there is an increased chance of successful extubation.
DEVELOPMENT AND VALIDATION OF A SCORE TO PREDICT MORTALITY IN CHILDREN UNDERGOING EXTRACORPOREAL MEMBRANE OXYGENATION FOR RESPIRATORY FAILURE: PEDIATRIC PULMONARY RESCUE WITH EXTRACORPOREAL MEMBRANE OXYGENATION PREDICTION SCORE
Bailly DK, Reeder RW, Zabrocki LA, et al. Crit Care Med 2017;45(1):e58-e66.
The aim of this retrospective study was to develop and validate a prognostic scoring tool to predict in hospital mortality for children (n = 4352) with respiratory failure at the time of initiation of extracorporeal membrane oxygenation (ECMO). The pediatric pulmonary rescue with ECMO prediction score included mode of extracorporeal membrane; pre-ECMO more than 14 days, pre-extracorporeal oxygenation severity of hypoxia, and diagnostic categories including asthma, aspiration, respiratory syncytial virus, sepsis-induced respiratory failure, pertussis, and other comorbid conditions of cardiac arrest, cancer, or renal or liver dysfunction.
Overall mortality was 43%, and there was no difference related to sex. Median duration of ECMO was 6 days, and overall 8% of these children were ventilated more than 14 days and, per the researcher, associated with increased mortality (P < .001). Mortality also increased with severe hypoxia and lower pH, sepsis-induced acute respiratory failure syndrome, immunodeficiency, and myocarditis. Asthma, aspiration, and respiratory syncytial virus were protective against mortality.
The authors found that the pediatric pulmonary rescue with ECMO prediction was a valid tool for predicting in-hospital mortality among children with respiratory failure receiving ECMO support. The authors also found that comorbid conditions influence overall mortality regardless of the primary diagnosis.